Institute for Healthcare Improvement: Campaign

Frequently Asked Questions about the 5 Million Lives Campaign

Welcome to the 5 Million Lives Campaign, the next wave of an ever-growing mobilization to transform US health care, led by the Institute for Healthcare Improvement (IHI) and many committed partners and hospitals. If you’ve been enrolled in the 100,000 Lives Campaign, you’ll find some of the information in these Frequently Asked Questions (FAQs) familiar. However, we invite you to become acquainted with the new aims and additional interventions of the 5 Million Lives Campaign. For hospitals new to an IHI Campaign, we hope the FAQs answer most of your questions; for additional information, please contact us at Campaign@IHI.org.

FAQs from the Campaign’s prior phase are accessible here.

Campaign Results and What's Next

An Overview of the 5 Million Lives Campaign (December 12, 2006-December 9, 2008)

Campaign enrollment FAQs for rural and CAH facilities

How the Campaign Works

Measurement and Data Submission

The First Campaign Initiative (100,000 Lives Campaign; December 14, 2004-June 14, 2006)

Lives Saved Calculation

Campaign Results and What's Next

Has the 5 Million Lives Campaign ended?

Though the 5 Million Lives Campaign came to a formal close on December 10, 2008, the support hospitals have come to expect from IHI’s Campaigns will not end. IHI will continue to help hospitals until patients everywhere receive the best care possible, every time.

IHI’s next frontier of hospital work is the IHI Improvement Map. Building on many years of hard work in hospitals and the momentum of the 5 Million Lives and 100,000 Lives Campaigns, IHI will now help hospitals improve patient care by focusing on an essential set of process improvements designed to achieve high levels of performance in areas that matter most to patients. The map will make sense of many complex and competing demands, making it possible for hospitals to find reliable routes to success.

Organizations can continue to access the rich content and support that was offered in the Campaigns, including How-to Guides, tools, and introductory calls, at no cost, and they will also be able to access new, vibrant forms of support. To learn more about the Improvement Map, please click here.

What did the 5 Million Lives accomplish?

Participants in the 5 Million Lives Campaign (and its predecessor, the 100,000 Lives Campaign) made exciting progress since the launch of the first initiative in December 2004. In the past few years, hospitals across the US have made unprecedented commitments to quality and patient safety, with many demonstrating impressive results. At its formal close in December 2008, the Campaign celebrated the enrollment of 4,050 hospitals, with more than 2,000 facilities pursuing each of the Campaign’s 12 interventions to reduce infection, surgical complication, medication errors, and other forms of unreliable care in facilities. Eight states enrolled 100% of their hospitals in the Campaign, and 18 states enrolled over 90% of their hospitals in the Campaign.

A field office (“Node”) manages local improvement activity in every state, and the Campaign identified 200 hospitals as mentors—teachers of peer facilities on all 12 of the Campaign’s interventions. Every day we witnessed great innovation and activity in the field – there were thirty events around the country in April of 2008 alone—and we expect that to continue.

Above all, we also witnessed striking signs of progress in improving patient outcomes. For example, 65 hospitals reported going a year or more without a ventilator-associated pneumonia, and 35 reported going a year or more without a central line-associated bloodstream infection in at least one of their ICUs. States have also accomplished a great deal; Rhode Island hospitals active in the Campaign reported a 42% decrease in central-line associated bloodstream infections from 2006 – 2007, and New Jersey has seen a 70% reduction in pressure ulcers through the work of 150 organizations across the state.

Did hospitals in the Campaign prevent five million instances of harm?

The short answer to this question is that we don’t know yet but IHI is hard at work to better measure progress against its primary aim—massive reduction of patient injuries—through several mechanisms.

First and foremost, IHI has just completed a state-level harm study to assess patient injuries in a geographic area, North Carolina. IHI sponsored the independent pilot study with the hope that it could serve as a proof of concept for a national study. Researchers focused on validating the methodology for detecting and trending harm over time within an organization, and sought to establish a protocol by which national rates of harm could be measured reliably and accurately.

This study—the North Carolina Patient Safety Study—used the IHI Global Trigger Tool to review a random sample of medical records over a six-year period in a random sample of hospitals in that state. Preliminary indications are that the Global Trigger Tool is a valid, reliable methodology for harm detection in individual hospitals and can be used to track rates of harm over time. The study suggests that a similar approach could be used to measure harm rates nationally.

The study was not powered to detect small changes in the rate of harm over time, but further analyses are ongoing to understand the trends that were observed. The study protocol was developed by two prominent independent health services researchers who work in the patient safety field: Chris Landrigan, MD, MPH (Principal Investigator), and Paul Sharek, MD, MPH (Co-Principal Investigator). Additional input was provided by a distinguished independent Scientific Advisory Group. To ensure objectivity and scientific rigor, an independent Clinical Research Organization—Battelle Inc.—conducted the study. IHI’s hope is that a national health care organization will conduct a national harm study using our pilot results and methodology as a guide, and that this national harm study will not just be a one-time assessment, but rather a continuous measurement project that will provide the country with a reliable metric of progress in this crucial area.

While we will not be releasing a national “harms avoided” number in December, IHI is studying the progress of Campaign hospitals in reducing mortality and harm in other ways.We are also working with other national organizations to tap into existing databases to measure changes in specific types of harm (e.g., medication error, infection, surgical complication). For instance, we have begun collecting information on hospitals “getting to zero”—reducing adverse event rates to zero for extended periods of time—in several appropriate intervention areas. We are also producing a number of articles for submission to peer-reviewed journals on progress in the Campaign, including forthcoming studies on mortality reduction and infection reduction that we hope will be accepted for publication in the near term.

These approaches together offer the beginnings of a rigorous system of reporting on the impact of the Campaign and other patient safety efforts in the nation.

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An Overview of the 5 Million Lives Campaign (December 12, 2006-December 9, 2008)

What is the aim of the 5 Million Lives Campaign?

The aim of the 5 Million Lives Campaign is to support the improvement of medical care in the US, significantly reducing current levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality. We have quantified this aim and set a numeric goal: we are asking hospitals participating in the Campaign to prevent 5 million incidents of medical harm over the next two years.

IHI estimates that 15 million incidents of medical harm occur in the US each year. That is based on an estimate of about 40 incidents of harm per 100 admissions (more than one harm event for every three admissions) and roughly 37 million hospital admissions per year in the US, according to the American Hospital Association (AHA). If successful by the Campaign’s deadline, the hospitals participating in the 5 Million Lives Campaign will have reduced national medical harm by approximately one third.

The 5 Million Lives Campaign actively seeks more hospitals to take part in this massive improvement in care practices; the goal is to enroll 4,000 American hospitals (building on the more than 3,100 facilities enrolled in our preceding initiative, the 100,000 Lives Campaign and to continue to nurture the national learning network of partners, field offices (nodes), and hospitals that has begun to take shape.

Why did IHI choose the number 5 million as the target for harm reduction?

We chose the number 5 million because it sets an extremely ambitious goal for participating hospitals and because, most importantly, we believe participating hospitals can achieve this goal. Based on the pioneering work of leading hospitals and estimates of the amount of harm that facilities can avoid when new practices are introduced, we know hospitals will have to improve their current processes at an unprecedented rate to reach our goal, but patients and families deserve no less. IHI also encourages hospitals to identify new interventions — a in addition to those already offered — as vehicles to propel all Campaign participants toward this aim more rapidly.

Approximately how much medical harm occurs annually in the US?

Using our definition of medical harm (see question below: “What is ‘medical harm’?”), IHI research, corroborated by academic colleagues, suggests that there are between 40 to 50 incidents of medical harm to patients for every 100 admissions (for the purposes of this calculation, we use a conservative estimate of 40 harm incidents per 100 admissions). With roughly 37 million hospital admissions per year in the United States (AHA National Hospital Survey for 2005), this leads us to conclude that there are (37 million admissions x 40 harm incidents / 100 admissions =) approximately 15 million incidents of medical harm per year in the US.

How bold is the Campaign’s aim? Is it too bold?

A two-year reduction of 5 million incidents of harm — which would represent avoiding one sixth of total national medical harm over that interval — is an extremely ambitious aim; indeed, it is a goal that some might declare too bold or even impossible. But given the performance IHI has observed in highly successful hospitals and given all that the industry is investing in improving the quality of care nationally, we must find a way to achieve such results in this period. Achieving this goal will require a massive, unprecedented shift in the expectations and practices of the national health care community, but for patients and families that are harmed by care every day, we must move as fast and as far as we possibly can.

How will IHI measure progress towards the goal of 5 million avoided incidents of harm?

Our current plan is to measure the change in rate of harm over time — from a baseline period in 2006 to the conclusion of the Campaign in December 2008 — within a representative sample of Campaign hospitals. Measurement of harm rate will likely be done by chart review and will likely be performed by experienced analysts not affiliated with the hospitals in the sample. The change in harm rate measured in sample hospitals would be applied to the patient volume of the Campaign, allowing a calculation of both the total expected harm (based on baseline period harm rates) and total actual harm during the Campaign period. The difference between the actual and expected harm will give the estimate of total “harms avoided.”

Why did IHI decide to expand the initiative’s focus to include harm?

We chose the goal of avoiding unnecessary deaths in the 100,000 Lives Campaign because death is the most extreme consequence of defects in our current health care system. Because hospitals made great strides in that initiative, they are now uniquely positioned to broaden their focus on the underlying causes of all types of harm that may occur in the hospital, for we know that for every fatal incident there many times more harm events. Participating facilities cannot and should not tolerate the sheer magnitude of infections, adverse events, and complications that patients endure during any given hospital stay.

The work of the Institute for Healthcare Improvement (IHI) and many of its partners is guided by the six aims for American health care articulated in the landmark Institute of Medicine (IOM) report, Crossing the Quality Chasm: safety, effectiveness, equity, timeliness, patient-centeredness, and efficiency. These aims translate into IHI’s “no needless list,” which describes even more explicitly the end state of the ideal system we are seeking to build:

No needless deaths
No needless pain or suffering
No helplessness in those served or serving
No unwanted waiting
No waste

…for anyone.

In the 100,000 Lives Campaign we took on needless deaths, and now we must transform the lives of American patients and families by taking on the needless pain and suffering associated with harm. In the future — and in IHI’s other, ongoing activities — we will continue to address the other articulated IOM aims, as well.

What is “medical harm”?

The 5 Million Lives Campaign defines “medical harm” as:

Unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment), that requires additional monitoring, treatment or hospitalization, or that results in death.

Such injury is considered medical harm whether or not it is considered preventable, whether or not it resulted from a medical error, and whether or not it occurred within a hospital.

Within the context of the Campaign materials, or in other contexts where the intent is similarly clear, “medical harm” is often shortened to simply “harm.” “Adverse Event” is also sometimes used to mean an incident of medical harm.

Notably, our definition explicitly states that medical harm is not the same as medical error. Some errors do indeed result in medical harm, but many errors do not, and, similarly, many incidents of medical harm are not the result of any errors.

How will the Campaign categorize different types of harm, if at all?

In IHI’s work on medical harm, we have found it useful to categorize harm by severity using a modification of the index of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). The NCC MERP index is actually a categorization of medical error, with categories A through D covering errors that do not result in harm, and categories E through I covering errors that result in harm of escalating severity. One modification of the original NCC MERP scale for our use is the removal of error from any category definitions, resulting in a new scale that begins at category E and that makes no statement about or requirement of error. A second modification is to apply the index to all types of medical harm, rather than only medical harm associated with medication treatment (the original index is limited to only medication errors).

Here is a list of the NCC MERP classifications of harm between category E and category I:

Category E: Temporary harm to the patient that required intervention;

Category F: Temporary harm to the patient that required initial or prolonged hospitalization;

Category G: Permanent patient harm;

Category H: Harm requiring intervention to sustain the patient’s life;

Category I: Patient death.

In measuring progress towards the goal of five million avoided incidents of harm, the Campaign plans to include categories E through I in aggregate. However, we also plan to measure changes in harm within each category, E through I.

The estimate of total medical harm in the United States in the 5 Million Lives Campaign is higher than prior national estimates — why?

Other national estimates of harm have looked only at harm events that fall between category F (harm that is temporary but does require additional hospitalization) and category I; this may explain discrepancies (i.e., a relatively high harm estimate in this Campaign), as category E accounts for about 60% of all harm between category E and category I. Other possible explanations for the high estimate of national harm in the Campaign include:

The measurement methodology used to reach our estimate (chart review using the IHI Global Trigger Tool ) is more sensitive than many other methods — for example, self-reporting or chart review without explicit triggers — so more harm is likely to be successfully identified;
As noted in the definition of medical harm above, the Campaign does not distinguish between preventable and non-preventable harm. From the standpoint of improvement, it is valuable to measure both, since it is often not clear which harm is preventable and which is not; similarly, as innovation occurs, some harm that is considered inevitable today might turn out to be preventable tomorrow;
Our estimate includes medical harm events that occur outside of the hospital that cause the patient to be admitted; some other national estimates exclude (or are not able to measure) non-hospital medical harm.

How long will the 5 Million Lives Campaign run?

The 5 Million Lives Campaign will run for 24 months, from December 12, 2006, until December 9, 2008.

How does the Campaign reduce harm and help save lives?

IHI and its partners in this Campaign encourage hospitals and other health care providers to take the following steps to reduce harm and deaths:

Prevent Pressure Ulcers... by reliably using science-based guidelines for prevention of this serious and common complication
Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection... through basic changes in infection control processes throughout the hospital
Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin
Reduce Surgical Complications... by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
Deliver Reliable, Evidence-Based Care for Congestive Heart Failure…to reduce readmission
Get Boards on Board….by defining and spreading new and leveraged processes for hospitals Boards of Directors, so that they can become far more effective in accelerating the improvement of care

The Campaign will also continue to offer support to hospitals as they introduce and sustain their work on interventions from the 100,000 Lives Campaign:

Deploy Rapid Response Teams…at the first sign of patient decline
Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack
Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"
Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time
Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"

When reliably implemented, all 12 of these interventions can greatly reduce morbidity and mortality. The Campaign also strongly encourages participants to pursue additional interventions to improve care; without such contributions we will not be able to meet our ambitious aim.

How do you know these interventions work?

If you go to the Materials tab in the Campaign area of the IHI website, you will find fully referenced literature that provides a foundation for each of the recommended interventions, along with success stories from practitioners who have led successful implementations.

How is the Campaign aligned with other national quality improvement initiatives?

Wherever possible, the 5 Million Lives Campaign has sought to align its aims, interventions, and measurement definitions with those of other major national initiatives that seek to improve the quality of health care. These significant overlaps are outlined in detail in two “crosswalk” documents available in the Materials section in the Campaign area of IHI.org.

Do hospitals need to commit to working on all of the new interventions, in addition to the interventions from the 100,000 Lives Campaign? What if we are just getting started on the first six interventions?

Hospitals are not required to adopt all of the interventions, although our hope is that hospitals will adopt as many as possible, as rapidly as possible, to deliver the care that patients deserve. If you are just getting started on interventions from the 100,000 Lives Campaign, that is fine; we would simply encourage you to clearly plan for sustaining your ongoing work and taking on new interventions in the months to come.

What if we are already doing great work in the intervention areas listed above?

It may be the case that your organization is already doing trailblazing work in the areas we’ve identified for improvement. Nevertheless, we encourage you to check your data, see where you can improve further, and identify new areas for improvement in your organization. We also welcome you to act as a mentor hospital to guide other facilities (see mentor hospital description below).

Do hospitals already enrolled in the 100,000 Lives Campaign need to enroll in this next initiative?

Hospitals do not need to officially re-enroll in this next initiative, though we would appreciate learning if you choose not to join. Hospitals will also be invited to reaffirm their commitment to this work — and identify the interventions they’re working on — by meeting the requirements of the first data collection period for the 5 Million Lives Campaign (for more on data submission see “Measurement and Data Submission” below).

What if we would like to pursue another improvement intervention as part of our Campaign activity?

You are more than welcome to do so. The Campaign interventions are meant to give hospitals a starting point for action, but we want to honor all of the important improvement initiatives that are seeking to save lives and we want to combine with all complementary projects and campaigns in pursuit of our goal. We will learn from — and share — other interventions and strategies for success.

How is the Campaign funded?

The Campaign is funded through several unrestricted educational grants from corporate and private philanthropies, and through IHI’s own investment. A full list of donors is available here.

How does the Campaign address the needs of patients and families? How have Campaign hospitals engaged patients and families in their work?

The Campaign strongly encourages hospitals to engage patients and families in their work — both in the design phase and when implementing interventions. For example, several organizations now have systems in place that enable family members to call the Rapid Response Team at the first sign of patient decline. And organizations have found that encouraging members of their community to carry medication cards at all times eases the medication reconciliation process and decreases the risk of adverse drug events upon hospital admission and discharge (forms available on the Materials tab in the Campaign area of the IHI website).

Patient- and family-focused explanations of each intervention in the 100,000 Lives Campaign, including suggestions about how to ensure that patients receive care that matches appropriate recommendations, are posted in English and Spanish on the IHI website. Organizations are encouraged to distribute these documents to their patients and patients’ family members and to discuss how the interventions are relevant to their care. Similar intervention-specific documents for patients and families will be available soon (in English and Spanish) for the new interventions in the 5 Million Lives Campaign.

IHI seeks to increase hospital partnerships with patients and families. If your organization has worked with patients and families in the Campaign, and you have a story, tool, or suggestion to share, please email campaign@ihi.org.

For additional information about the growing collaboration between health care providers and patients and families to improve care, consult additional resources on ihi.org.

How do you plan to publicize the results and progress of this new Campaign?

IHI’s website, and the Campaign area in particular, highlighted hundreds of stories about Campaign participants during the 100,000 Lives Campaign. As of June 2006, the initiative had reached over 100 million people, with media coverage on everything from hospitals dramatically reducing infection rates to literally saving lives with Rapid Response Teams. With your permission and cooperation, the Campaign’s communications team plans a similarly robust publicity strategy during the 5 Million Lives Campaign, highlighting all of the great work that you share with us.

Where we are able to aggregate significant achievements of many Campaign hospitals, we will prominently post results on ihi.org and issue press releases to national, regional, and local media. In other instances we will alert reporters to the accomplishments of specific hospitals in a particular community and/or the notable work of multiple hospitals working on a particular intervention. You will hear about all these opportunities in the bi-weekly Campaign bulletin and during Campaign conference calls. At any stage in the process, you can let the communications team know of your progress by emailing campaign@ihi.org. We are also always happy to collaborate with your public relations staff on effective communications strategies.

How can my hospital or system's progress be highlighted by IHI, including being posted on ihi.org?

The most effective way to have your progress highlighted by IHI is to be in touch regularly with your Campaign Node, the Campaign’s field team, and the Campaign’s communications team about your work and accomplishments. Armed with the best information, the Campaign may ask a writer to contact you for inclusion in a feature story on ihi.org; we may invite members of your improvement team to join a Campaign conference call so others can benefit from your experiences; we may ask you to fill out an improvement report or a Success Headline specially designed for easy posting on ihi.org; finally, with your permission, IHI leaders and staff may want to mention your organization’s accomplishments in speeches and presentations. The more we know about your work, the more we can highlight it!

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How the Campaign Works

What does it cost to join the 5 Million Lives Campaign?

There is no cost to join. The support and resources described here are all offered to all participants free of charge.

We just learned about the Campaign; how do we get started?

If you were not enrolled in the 100,000 Lives Campaign, the first step is to let us know that you want to join the next initiative: Please go to the Sign Up tab for more information. You can help enroll your organization by encouraging the organization’s leaders to take part, and they can enroll by completing the official enrollment form and faxing or emailing it to us to begin the formal enrollment process. There are separate enrollment forms for individual facilities, systems, and partners.

If you were enrolled in the 100,000 Lives Campaign, you do not need to re-enroll (as noted above, you will be given an opportunity to re-affirm your enrollment during the first data submission period for the 5 Million Lives Campaign).

What types of support and resources will the Campaign offer to hospitals working on the Campaign interventions?

Everything you need to know to implement change at your institution is available for free in the Campaign area of IHI's website; there you will find an overview of the Campaign, detailed information about the interventions, improvement methods, Getting Started Kits, recordings of informational calls, tools, success stories, and resources. We continually add information about experts and peers working on the same changes who are prepared to help you.

To get the most out of all the supports the Campaign website provides, download a Guide to Campaign Web Resources or take a brief Campaign Web Site Tour.

Is the Campaign only for hospitals?

We have chosen hospitals as the leading edge of this Campaign because that’s where many of the improvements we’ve identified have been introduced and tested (and because more patient deaths due to avoidable errors occur in hospitals). However, everyone who works in health care has an important role to play. Regardless of the setting you work in or your position the leadership role you can play by influencing your local hospital’s leaders and Board of Trustees to join this Campaign. You can also encourage other doctors in your community to pursue the improvement interventions and agree upon associated standards of care. Above all, you can make these improvements yourself (all health care providers, for instance, can contribute to an intervention like medication reconciliation) and be an agent of change and a mentor in your area.

In addition, several of the interventions (e.g., medication reconciliation, reliable care for congestive heart failure, pressure ulcer reduction) have relevance to outpatient settings, and we are exploring how we might better engage these practices, along with patients, families, and other stakeholders in the care process, in rapid, national improvement.

Can organizations outside of the United States participate in the Campaign?

Yes, we welcome and encourage organizations from outside of the United States to participate in the Campaign. We collect and track mortality data from international organizations, though it does not count towards our domestic goal. (Note: If you are a Canadian provider, you may enroll directly with "Safer Healthcare Now!" — Canada’s related initiative to reduce mortality and morbidity).

As we learn from the experiences of US organizations and Nodes, and from those organizations outside of the US that have launched their own campaigns, we will offer information about how to develop local campaigns.

International toll dial-in numbers are available for Campaign calls and recordings of each call are posted to the web, typically within two or three days of the live call.

My hospital would like to end its formal enrollment in the Campaign. How should I let IHI know?

If your hospital would no longer like to be a part of the Campaign, you can opt out by noting this in your hospital profile on the IHI Extranet (or contact us directly at Campaign@ihi.org). We hope that you will continue to make use of the free resources and learning opportunities made available through the Campaign, but if you choose not to stay in the initiative on a formal basis, we would appreciate your sending an email to Campaign@ihi.org explaining your reasons so we might learn from your experience.

What is a Partner?

Partners are organizations affiliated with the Campaign that are not hospitals or systems — these organizations might include state hospital associations, quality improvement organizations, specialty patient groups, and other groups with leverage to expand this work. For a full listing of Campaign partners, please go to the Participants tab.

What is a Node (field office)?

Providing effective, timely support to Campaign hospitals on such a large scale requires a robust national network to support implementation and communication — what we call Field Operations. Nodes are organizations that have committed to acting as local field offices around the country. A Node may be a large system, an organization such as a hospital association, or a group of organizations working together to form a coalition (Quality Improvement Organizations, Hospital Associations, Medical Societies, etc.). Nodes manage "networks" — collections of approximately 50-100 hospitals grouped by geography, system membership, or affinity (e.g., pediatric hospitals, rural hospitals).

If your organization is interested in becoming a Campaign Node, please submit a Node Certification Request Form, available on the Sign Up tab of the Campaign area of the IHI website.

The Campaign has also identified several affinity groups in areas like pediatrics and rural health care; these organizations are listed under the Participants tab.

Who is my Node?

Campaign Nodes are high-leverage organizations (e.g., national associations, state medical groups and/or coalitions, big systems) acting as Campaign field offices. Many hospitals want to know if they are required to work with a Node and if there is a particular Node to which they should be assigned. The answer to both questions is "no." Nodes are organizations that have volunteered to give participating hospitals added support in the Campaign, offering their own experience and expertise to help wherever possible; hospitals should take advantage of any node whose services appear useful to them. Nodes cannot and do not require that Campaign participants join them, but their generosity and assistance are invaluable. See the Participants tab for a complete list of Nodes.

What is a Mentor Hospital?

We have a growing list of Mentor Hospitals (hospitals experienced at introducing the Campaign interventions) with representatives available to answer your questions and share ideas. Consult the Campaign Mentor Hospital Registry, organized by intervention and featuring information on the size and type of each mentor facility, for more information.

Is the Campaign looking for mentor hospitals for the six new interventions?

Yes. If you’ve had success at introducing any one of the six interventions at the heart of the 5 Million Lives Campaign, and would like to act as a coach to peer facilities, please contact us a campaign@ihi.org.

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Measurement and Data Submission

What will you measure in the 5 Million Lives Campaign? Will you continue to count lives saved?

At the Campaign level, we currently plan to measure two things:

1. The number of acute care inpatient deaths that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care (“Lives Saved”)

2. The number of incidents of medical harm that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care (“Harm Avoided”)

We will collect “lives saved” data through direct submission of acute care inpatient mortality data from participating hospitals. We plan to collect data on “harm avoided” by conducting retrospective chart review in a representative sample of participating facilities.

How do we measure harm in our hospital?

In order to measure harm across your facility, the most comprehensive approach is a retrospective review of patient records (charts). In order to do this effectively, a good place to start is the Global Trigger Tool. The Global Trigger Tool — available for free on the IHI web site — offers an approach for conducting a retrospective review of charts using “triggers” or clues to identify harm events. Early in the Campaign we will make available a series of calls and supports to more clearly describe this tool and its application.

Hospitals and hospital leaders will also benefit from close tracking of intervention-level measures as a proxy for tracking overall success in reducing harm.

What are the data submission requirements for the 5 Million Lives Campaign?

The data submission requirements for the 5 Million Lives Campaign are essentially the same as those for the 100,000 Lives Campaign. There are two components of required data submission:

1. Acute Care Inpatient Mortality data (deaths and discharges)

2. Submission and periodic update of a “Hospital Profile,” a questionnaire that describes basic administrative and demographic characteristics of your hospital

Are there any other data submission requirements?

No. However, the Campaign recommends “intervention-level measures” — measures such as Codes per 1000 Discharges (a Rapid Response Team intervention-level measure) and Percent AMI Patients Receiving Aspirin at Arrival (an AMI Care intervention-level measure) — that we feel hospitals should use internally to track the progress of their work at a more detailed level. Hospitals are not required to submit these measures, but we encourage them to do so. Intervention-level measures are submitted in very much the same way that the required Acute Care Inpatient Mortality data is submitted (described below).

Will hospital-specific data be reported publicly? What will be reported publicly?

Hospital-specific data, including Hospital Profile, mortality, and intervention-level data, will NOT be published. With the permission of hospitals, the Campaign will post the name and location of participating hospitals. Our current plans for public reporting include the total number and names of enrolled facilities and systems, the names of facilities that have submitted all required data (the “Fully Committed List”), the number of “Lives Saved” in aggregate over all Campaign hospitals, and the number of “Harm Events Avoided” in aggregate over all Campaign hospitals. We may report additional progress-related information, but always in aggregate so that individual hospital information is not revealed.

Will I still be able to submit data through a Data Intermediary?

Yes. Most organizations serving as Data Intermediaries in the 100,000 Lives Campaign will continue to serve as such in the 5 Million Lives Campaign. A list of participating Data Intermediaries can be found below.

When should my hospital submit data?

If your hospital has just joined the Campaign, you should submit your profile data and all available mortality data as soon as your team page is available on our website (key contacts will receive a welcome email with instructions when this happens). After this initial submission of data, hospitals should submit all new available data during the designated quarterly data submission periods, described below.

What is the data submission schedule?

Data submission periods are one month long and occur every quarter. The next several data submission periods are the following:

Data submission periods are typically one month long and occur roughly every quarter. The next several data submission periods are as follows:

April 1, 2008 – April 30, 2008 (submission of new mortality data and, if necessary, updated profile information)

July 1, 2008 – July 31, 2008 (submission of new mortality data and, if necessary, updated profile information)

October 1, 2008 – December [TBD], 2008 (the final push: mortality data up through August 2008; updated profile information)

How should hospitals submit Campaign data?

Hospitals may submit data directly to IHI online using an application on our website, www.ihi.org/extranetng, or hospitals may choose to submit data through one of a few Campaign-authorized "Data Intermediary" organizations, which will then forward the information to IHI. At present, Data Intermediaries for the 5 Million Lives Campaign include ACS-MIDAS+; Ascension; CareScience; Cerner; Hospital Corporation of America (HCA); Minnesota Alliance for Patient Safety (MAPS); Premier; Tenet; Veterans Health Administration; and VHA, Inc. Recorded training sessions and detailed instructions explaining how to use the IHI data submission tool are in the Materials section of the Campaign website.

Are data submission requirements different if the enrolled hospital is part of a system?

Whether or not a hospital is part of larger system, IHI is asking for the same Hospital Profile and hospital-specific inpatient mortality data; we are not collecting mortality data aggregated at the system level. A hospital that is part of a system that has been authorized to act as a Data Intermediary may submit its information through that system, but the data itself will be the same.

How do you verify information that hospitals send you?

Data submitted to IHI are subjected to basic integrity checks (e.g., existence of both numerator and denominator when appropriate, validation that the numerator value is less than or equal to the denominator value when appropriate), and unusually high or low values in a hospital’s monthly calculated lives saved per discharge are investigated by contacting the key contact. However, IHI does not audit data abstraction or collection processes at participating hospitals.

The crucial information we collect from hospitals is the mortality data, which are the only measure data used in the lives saved calculation. In terms of data integrity, we are confident in our results —even without hospital site audits — for the following reasons:

1. There is no substantial benefit to a hospital or system to deliberately alter its mortality data; all results are aggregated and we do not comment on individual hospital results.

2. We believe that the most common mistake in data reporting is that operational definitions in the measures are not understood. Mortality measures are very straightforward in terms of these definitions (death is an unambiguous event, for example), so we think hospitals will find it relatively easy to collect these data accurately.

3. Our calculation approach only compares a hospital to itself over time, so even if an operational definition is misapplied, the lives saved results will remain without bias as long as the operational definitions are applied consistently over time.

What if I still have questions about data submission?

Most questions about data submission can be answered in the Data Submission How-to Guide. The Data Submission Troubleshooting Guide should also prove helpful. If you still have questions, please email campaign@ihi.org.

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The First Campaign Initiative (100,000 Lives Campaign: December 14, 2004-June 14, 2006)

What was the aim of the first Campaign initiative (100,000 Lives Campaign)?

The 100,000 Lives Campaign was a nationwide initiative of the Institute for Healthcare Improvement (IHI) with a focus on significantly reducing mortality in American health care, which ran from December 2004 through June 2006. Building on the successful work of health care providers from all over the world, it introduced proven best practices to help participating hospitals across the country with the goal of extending or saving as many as 100,000 lives.

Why did you launch the 100,000 Lives Campaign when you did?

Thousands of hospitals and health care organizations are working hard on making health care safer and more effective. They deserve congratulations and encouragement. However, the pace of change in health care overall remains slow and fragmented, and most importantly, patients continue to be harmed. We started the Campaign in the belief that patients deserve a far better system — one based upon best practices that are known to reduce harm and save lives. After years of testing life-saving improvement methods on a small scale, IHI and its partners believe these same methods can and should be implemented rapidly on a much wider scale.

Why did you choose the number 100,000?

Because we believed that hospitals could achieve this goal in 18 months. Based upon our desire to improve care rapidly and spread these changes broadly, we engaged over 3,000 hospitals to introduce the improvement interventions at the core of this initiative (see below), and more are joining us every day. It was an ambitious goal, but one that we believed we should pursue in order to give as many patients as possible the care that they deserve.

How did the 100,000 Lives Campaign aim to reduce harm and help save lives?

IHI and its partners in this Campaign encouraged hospitals and other health care providers to take the following steps to reduce harm and deaths:

Deploy Rapid Response Teams…at the first sign of patient decline
Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack
Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"
Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time
Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"

When reliably implemented, these interventions — which are now a part of the 5 Million Lives Campaign — will greatly reduce morbidity and mortality.

As our work together progresses, participating facilities must also devote attention to holding the gains they make and to spreading successful interventions throughout their hospitals and systems so that we can move on to new challenges together.

What made the 100,000 Lives Campaign unique?

While there are a number of very worthy national quality improvement initiatives in the country, we believe that the 100,000 Lives Campaign stood out because of its bold aim (saving 100,000 lives), ambitious pace (trying to meet that aim in 18 months), broad reach (over 3,000 hospitals enrolled), and relentless focus on support for participating hospitals (largely through our national learning network consisting of partners, nodes, and mentor hospitals). In addition, we think the Campaign brought a great optimism to quality improvement efforts throughout the health care industry, demonstrating tremendous levels of cooperation and showing that providers will bring the same level of devotion to this work that they bring to patient care every day. Ultimately, we hope this leads to a lasting change in the standard of care in the country. The dream is that one day our friends and family members will never suffer from the infections and errors that the Campaign targeted.

(Note: We welcome your thoughts — positive or negative — on this question, as well.)

How many lives were saved in the first 18 months of the 100,000 Lives Campaign?

The Campaign estimates that participating hospitals saved 122,300 lives in the Campaign’s first 18 months. In other words, due to improvements in care (some related to the Campaign, some not), an estimated 122,300 inpatients did not die during the Campaign period that we would have expected to die given 2004 levels of care.

How did IHI calculate lives saved for the 100,000 Lives Campaign?

Hospitals participating in the Campaign were required to submit monthly raw mortality data (deaths and discharges) to IHI for both the entire Campaign period (January 2005 – June 2006) and the 18 months prior (July 2003 – December 2004). The Campaign calculated the “lives saved” contribution by a particular hospital for a particular month in the Campaign period by comparing that hospital’s data for that month to that hospital’s data for that month in the baseline period, with a national patient mortality risk adjustment applied to account for the overall change in patient acuity between baseline and Campaign periods. The sum of all these individual hospital months of lives saved over all months and all participating hospitals yielded the overall Campaign total lives saved. Note that the baseline period was always 2004; Campaign period months in 2006 were still compared to that month in 2004, not 2005.

For more detailed information on the calculation of lives saved at the national, system, and hospital level, see the 100,000 Lives Campaign – Lives Saved FAQs and articles in the ACP Guide for Hospitalists or Joint Commission Benchmark.

You’ve described the lives saved figure as an “estimate”; how confident are you that your estimate was correct?

The point estimate we’ve given is our best estimate of lives saved during the 100,000 Lives Campaign period, using a fairly conservative calculation. However, because of the statistical nature of our approach, it’s actually extremely unlikely that the number we’ve given is exactly equal to the “true” number of lives saved. To give a better idea of the possible range within which the true number of lives might fall, we have calculated lower and upper bounds (115,400 and 148,800 respectively) that describe what we believe to be the reasonable lower and upper limits of where that true number might lie. So, to answer the question directly: we believe that our point estimate is the best single value guess at the “true” value of lives saved, but we cannot say that it is exactly correct. We are very confident that the true value falls in between the upper and lower bounds that we’ve given.

How many of the lives saved were due to the six interventions? How many of the lives saved were due to the influence of IHI and the Campaign in general?

We do not know at this point. The main measurement priority in the 100,000 Lives Campaign was to assess the total effects of all quality improvements in participating hospitals (i.e., efforts related to the Campaign, and efforts related to other improvement activities as well), but we are also interested in trying to isolate the effects of the six interventions and the Campaign in general.

Our research tells us that there has been a trend of improvement in US hospital quality of care over the last several years — i.e., that US hospitals have been saving lives for the last several years. We believe that the 100,000 Lives Campaign accelerated and contributed to this trend, but we have not isolated its impact.

We are beginning to spend more time exploring these questions. As our research progresses, we will make all findings public.

Were hospital-specific data publicly reported? What will be reported publicly?

Hospital-specific data, including Hospital Profile, mortality, and intervention-level data, was not published. With the permission of hospitals, the Campaign posted the names and locations of participating hospitals. We publicly reported the total number and names of enrolled facilities and systems, and the number of lives saved in aggregate over all Campaign hospitals. Any additional progress-related information would only be reported in aggregate so that individual hospital information is not revealed.

Has IHI conducted a complete evaluation of results from the 100,000 Lives Campaign?

Throughout the 100,000 Lives Campaign, we sought meaningful ways to better understand the initiative’s results beyond the lives saved count and the information hospitals have volunteered to the Campaign team. For example, we’re very interested in understanding how many of the total lives saved can be attributed directly to the Campaign’s influence, or to work on the Campaign’s six interventions; we’re interested in understanding which Campaign materials and support vehicles were the most valuable to participants and partners; and we’re interested in understanding the degree to which the standard of care at the intervention level has changed. These are questions that we will continue to pursue as we enhance our feedback systems and move forward.

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Lives Saved Calculation

For more detailed information on the calculation of lives saved at the national, system, and hospital level, see “100,000 Lives Campaign – Lives Saved FAQ.” Also, please reference the articles available here:

"The hard count: Calculating lives saved in the 100,000 Lives Campaign" from ACP Guide for Hospitalists

"Interpreting the "Lives Saved" Result of IHI's 100,000 Lives Campaign" from the Joint Commission Benchmark