A Model for the Departmental Quality Management Infrastructure Within an Academic Health System.
As quality improvement and patient safety come to play a larger role in health care, academic medical centers and health systems are poised to take a leadership role in addressing these issues. Academic medical centers can leverage their large integrated footprint and have the ability to innovate in this field. However, a robust quality management infrastructure is needed to support these efforts. In this context, quality and safety are often described at the executive level and at the unit level. Yet, the role of individual departments, which are often the dominant functional unit within a hospital, in realizing health system quality and safety goals has not been addressed. Developing a departmental quality management infrastructure is challenging because departments are diverse in composition, size, resources, and needs.In this article, the authors describe the model of departmental quality management infrastructure that has been implemented at the Johns Hopkins Hospital. This model leverages the fractal approach, linking departments horizontally to support peer and organizational learning and connecting departments vertically to support accountability to the hospital, health system, and board of trustees. This model also provides both structure and flexibility to meet individual departmental needs, recognizing that independence and interdependence are needed for large academic medical centers. The authors describe the structure, function, and support system for this model as well as the practical and essential steps for its implementation. They also provide examples of its early success.
S.C. Mathews is research fellow, Armstrong Institute for Patient Safety and Quality, and clinical fellow, Division of Gastroenterology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland. R. Demski is vice president for quality improvement, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine and Johns Hopkins Health System, Baltimore, Maryland. J.E. Hooper is interim director of autopsy and assistant professor of pathology, Johns Hopkins University, Baltimore, Maryland. L.D. Biddison is vice chair for clinical affairs, Department of Medicine, and assistant professor of medicine, Johns Hopkins University, Baltimore, Maryland. S.A. Berry is associate vice chair for quality, safety, and service, and assistant professor of medicine, Johns Hopkins University, Baltimore, Maryland. B.G. Petty is chair, Pharmacy and Therapeutics Committee and Clinical Quality Improvement Committee, and associate professor of medicine, Johns Hopkins University, Baltimore, Maryland. A.R. Chen is vice chair for quality, safety, and service, and associate professor of oncology and pediatrics, Johns Hopkins University, Baltimore, Maryland. P.M. Hill is vice chair for clinical affairs, Emergency Medicine, and associate professor of emergency medicine, Johns Hopkins University, Baltimore, Maryland. M.R. Miller is vice chair for quality and safety, Children's Center, and professor, Departments of Pediatrics and of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland. F.R. Witter is vice chair for quality, safety, and service, and professor of gynecology and obstetrics, Johns Hopkins University, Baltimore, Maryland. L. Allen is chief patient experience officer, Johns Hopkins Hospital, Baltimore, Maryland. E.C. Wick is associate professor of surgery, Johns Hopkins University, Baltimore, Maryland. T.S. Stierer is director of clinical quality, Ambulatory Anesthesia Division, Department of Anesthesiology and Critical Care Medicine, and associate professor of anesthesiology and critical care medicine, Johns Hopkins University, Baltimore, Maryland. L. Paine is director of patient safety, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland. H.A. Puttgen is assistant professor of neurology, Johns Hopkins University, Baltimore, Maryland. R.J. Tamargo is professor of neurosurgery, Johns Hopkins University, Baltimore, Maryland. P.J. Pronovost is senior vice president for quality and safety, Johns Hopkins Medicine, director, Armstrong Institute for Patient Safety and Quality, and professor, Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland.
Simon C
SC
Mathews
Renee
R
Demski
Jody E
JE
Hooper
Lee Daugherty
LD
Biddison
Stephen A
SA
Berry
Brent G
BG
Petty
Allen R
AR
Chen
Peter M
PM
Hill
Marlene R
MR
Miller
Frank R
FR
Witter
Lisa
L
Allen
Elizabeth C
EC
Wick
Tracey S
TS
Stierer
Lori
L
Paine
Hans A
HA
Puttgen
Rafael J
RJ
Tamargo
Peter J
PJ
Pronovost
D000046:Academic Medical Centers / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D017146:Models, Organizational; D061214:Patient Safety; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*