In several earlier posts, I have talked about how the use of benchmarks can be inimical to clinical quality improvement, stating a preference instead for absolute targets, like zero or 100%. I understand this to be a controversial view, and you can see an excellent discussion on the topic in this post, with thoughtful comments offered by Marya Zilberberg and others.
It is reassuring to me, then, when I see respected health care systems adopting the more targeted approach -- and getting consistently great results. An example is the University of Michigan Health System, whose Surgical Intensive Care Unit (SICU) and Trauma Burn Intensive Care Unit (TBICU) will receive an outstanding achievement and leadership award for eliminating ventilator-associated pneumonia (VAP). The award is co-sponsored by the U.S. Department of Health and Human Services (USDHHS) and the Critical Care Societies Collaborative (CCSC), which is composed of the American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine.
The award requires consistent performance -- 25 months or longer -- accompanied by national leadership in sharing evidence-based practices with others. Well beyond two years, the U of M teams have shown results for more than 9 years.
The philosophy that is in place is set forth in the University's press announcement.
At any given time in the United States, 1 in 20 inpatients have an infection associated with health care they have received, and every year about 99,000 people die from a healthcare-associated infection (HAI).
Can HAIs be eliminated altogether? The University of Michigan says yes.
Transparency is part of this success. Here's the chart showing compliance with the bundle of steps taken to avoid ventilator associated pneumonia in all the ICUs, not just the two mentioned above. This and other metrics are available for the world to see on the system's website.
Modesty must be inherent in this kind of transparency. After all, you can't just show good results. You have to show all results. The point of transparency is to hold yourself accountable to the standard of care you say you believe in. You learn from both successes and failures, and the learning is shared broadly throughout the institution. It takes leadership at all levels in the organization to pull this off because there are always folks who will want to retrench and avoid the perceived potential of embarrassment when results are other than stellar (not to mention lawyers who overstate the legal risks of such disclosure.)
As the U of M has shown, this is all worth it. Hundreds of lives have been saved, people whose deaths previously would not even have been reportable as adverse events. Congratulations!