title: Sustaining Reliability on Accountability Measures at The Johns Hopkins Hospital.
abstract: BACKGROUND
  In 2012 Johns Hopkins Medicine leaders challenged their health system to reliably deliver best practice care linked to nationally vetted core measures and achieve The Joint Commission Top Performer on Key Quality Measures ®program recognition and the Delmarva Foundation award. Thus, the Armstrong Institute for Patient Safety and Quality implemented an initiative to ensure that ≥96% of patients received care linked to measures. Nine low-performing process measures were targeted for improvement-eight Joint Commission accountability measures and one Delmarva Foundation core measure. In the initial evaluation at The Johns Hopkins Hospital, all accountability measures for the Top Performer program reached the required ≥95% performance, gaining them recognition by The Joint Commission in 2013. Efforts were made to sustain performance of accountability measures at The Johns Hopkins Hospital.
  
  
  METHODS
  Improvements were sustained through 2014 using the following conceptual framework: declare and communicate goals, create an enabling infrastructure, engage clinicians and connect them in peer learning communities, report transparently, and create accountability systems. One part of the accountability system was for teams to create a sustainability plan, which they presented to senior leaders. To support sustained improvements, Armstrong Institute leaders added a project management office for all externally reported quality measures and concurrent reviewers to audit performance on care processes for certain measure sets.
  
  
  CONCLUSIONS
  The Johns Hopkins Hospital sustained performance on all accountability measures, and now more than 96% of patients receive recommended care consistent with nationally vetted quality measures. The initiative methods enabled the transition of quality improvement from an isolated project to a way of leading an organization.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Christine G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: Tiffany
authors.initials: T
authors.lastname: Callender
authors.forename: Renee
authors.initials: R
authors.lastname: Demski
authors.forename: Laura
authors.initials: L
authors.lastname: Winner
authors.forename: Richard
authors.initials: R
authors.lastname: Day
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Austin
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D003142:Communication; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D061214:Patient Safety; D017064:Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D013192:Staff Development; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States