Institute for Healthcare Improvement: 100,000 Lives Campaign Blog Entries

Wednesday, October 18, 2006: Tremors, Mayors, and Health Care Players in Hawaii

Over 18 months after the start of the Campaign, the field team has been to at least 120 hospitals in 39 states. Not surprisingly, in that time visits have been cancelled for a whole host of reasons – illness, surprise guests (perhaps from one of our national partners?), etc. But we’ve never before had a cancellation because of a natural disaster. So, in addition to being shaken by the 6.7 quake that rocked the Big Island on Sunday, October 15 at 7:05, I was sorry to learn about the structural damage at Kona Community Hospital which closed several of their units and caused discomfort and angst for its patients and caregivers.

Fortunately for Dr. Bob Wilmouth, Board member of the Mountain Pacific Quality Healthcare Foundation, and I, Hilo Medical Center was not directly affected by the quake, and was eager for a visit. Our host, Gail Rhoades, received us graciously with Hawaiian leis and a very warm “aloha.” We then met their teams, including VAP Team Leader, John Holloran, who is a Campaign Mentor. Hilo is one of the growing number of hospitals that have gone over one year without a Ventilator Associated Pneumonia! We also discussed strategies to expedite the implementation of their Rapid Response Team, collect and measure data more effectively, and tackle medication reconciliation.

Hospital CEO, Ronald Schurra, was thoroughly engaged in our conversations and led a Campaign Rally following our meeting and tour. Big Island Mayor, Harry Kim, joined us and offered some words of inspiration. To my knowledge, the presence of a local mayor at a site visit was another Campaign first.

The following day, I had the opportunity to provide a keynote address at the annual conference of the Hawaii Node in Honolulu. The audience was wonderfully receptive, and I had the opportunity to spend time with Campaign friends Dr. Della Lin of the Governance Institute and Donna Daniel of Qualis Health.

Dr. Bob and I left Hawaii very impressed with their progress and the hopes that we’ll be invited back soon.

Hilo Medical Center’s, Ronald Schurra and Gail Rhoades, welcomed Hilo Mayor, Harry Kim, Montana Node representative, Dr. Bob Wilmouth, and Campaign National Field Manager, Matt Louchheim, during a recent visit.

Tuesday, October 17, 2006: Wisconsin Quality & Safety Forum caps off fall tour of the Midwest

Collaboration is the name of the game here in the Midwest, where caregivers have been assembling in record numbers to share best practices on the Campaign interventions. I just returned from Stevens Point, Wisconsin, where IHI Rapid Response Team expert, Kathy Duncan, and I, along with 200+ caregivers and payers from all over the state, attended the Wisconsin Quality & Safety Forum. Metastar and the Wisconsin Hospital Association (both members of the Node) did a great job convening this meeting. A personal highlight for me was the chance to reconnect with representatives from Columbia St. Mary’s and Aurora Sinai, two Systems I visited back in February.

Wisconsin, of course, was just one of many Midwest destinations for the field team this fall. Back in September, IHI Director, Marie Schall, along with Matt Louchheim and I traveled to Lincoln, Nebraska, where caregivers were beaming over the great results harvested through their conscientious improvement work. St. Elizabeth Regional Medical Center, a member of Catholic Health Initiatives, has leveraged their position in this strong system to drive change on the hospital level. We also learned of how they had achieved leadership buy-in by making their data more transparent. Down the street, BryanLGH had successfully engaged their Board by calculating cost savings for fewer VAPs and by using multidisciplinary rounds on every patient in their facility. It was an inspiring trip with some great views of the cornfields in bloom!

My visit to William Beaumont in Royal Oak, Michigan started the month of October off with a bang. Their enthusiasm was infectious, and Jim Conway and I heard about record numbers of Rapid Response Team calls and the kinds of results one would only expect from a fully engaged staff. We then joined the Michigan Node at their 2006 Quality Expo at the Mt. Pleasant Casino. There, Jim gave a stirring address on his time spent at the Dana Farber Cancer Institute, while I spoke about the Campaign. Both of our talks generated many thoughtful questions. It’s evident that there are countless Michigan hospitals like Beaumont, tenacious in their efforts to drive improvement even further using new best practices.

In the week leading up to Wisconsin, Fran Griffin and I managed to bring the Campaign message to caregivers from all over the very large and geographically diverse state of Ohio, covering two major cities in three days. At the Ohio Patient Safety Institute (OPSI) in Columbus, we spoke on the Campaign approach to spreading change as well as concepts of reliability. From Columbus, we headed south to Cincinnati, where the Ohio Hospital Association had organized a Town Hall meeting of local systems to facilitate the sharing of best practices and to solicit advice on how we could improve communications in the next Campaign. It proved an effective format for fostering collaboration among caregivers; furthermore, the OPSI is an excellent forum for bringing hospitals together to collaborate on Campaign-related issues, and I look forward to working with them again next year.

I will be spending much of November planning for travel in the Midwest next year…stay tuned!

National Field Manager, Matt Louchheim, and Central Region Field Coordinator, Jonah Borrelli, join BryanLGH in celebrating a year of zero VAPs.

After pulling off an exciting Iowa Node Work Day, IHI Faculty Member and Iowa Healthcare Collaborative CEO/President, Dr. Tom Evans, decided to join me on a trek to Bismarck, North Dakota. With help from the North Dakota Medical Association, we had the opportunity to visit Medcenter One and St. Alexius. Both hospitals have demonstrated significant improvement in the six interventions, which would not have been possible without dedicated physicians and quality departments. We also received a very warm welcome from the Medical Association, which had invited us to speak about the Campaign and its Node infrastructure. Hopefully, the Campaign will pick up greater traction throughout the state so that we can find an excuse to come back and visit with the wonderful people here!

Hello from IHI Director, Fran Griffin, on the road again, meeting with participants in the Campaign. Yesterday’s visit to Seattle was organized as a town hall meeting, with many hospitals attending. The focus was on medication reconciliation and Washington has some great local experts.

Following the meeting, our gracious hosts at Campaign Mentor Hospital, Harborview Medical Center, gave us a tour.

We went to a med-surg floor where they asked two nurses (who clearly were not expecting this) to tell us about their Rapid Response Team. The nurses really praised it, mentioned that they called often and, when asked how many patients might have been saved, answered “lots.” You could see the pride and joy in their reaction when they heard the actual decrease in floor codes hospital wide (from 33% to 11%). As we were talking to them, a physician who happened by was also pulled into the discussion. He also talked about the benefits of their Rapid Response Team. We learned that Harborview built their Rapid Response Team on the foundation of the STAT nurse program they’ve had for 14 years.

In the SICU, one of Harborview’s nurses talked about their vent bundle work and rattled off tons of information (without notes) about how they tested staff knowledge on HOB angles and studies published about the various interventions. The passion and knowledge were clear.

It was obvious that this work is totally and completely engrained in front line culture. They are really doing it.

Greetings from the Iowa Node Work Day at Mercy Medical Center in Des Moines! The Iowa Node, which is led by the Iowa Healthcare Collaborative, meets twice a year to provide status reports on the six Campaign Interventions, take advantage of cutting-edge learning in quality improvement, and share successful strategies in implementing life-saving changes in their hospitals. It’s an environment where “All Teach, All Learn” rings true, and where I observed Critical Access Hospitals mentoring Academic Medical Centers and vice versa. The Iowa Node has identified five hospitals to serve as IHI Campaign Mentors, and use of the Mentor Network permeated the day’s discussions. Michelle Kelly, RNC, MSN, Director of Quality and Community Services at Buena Vista Regional Medical Center, described how the Mentor Network connected a hospital in Australia to her 25-bed Critical Access Hospital in Storm Lake, Iowa. There’s little doubt that as globalization shrinks our world, the Campaign community continues to grow . . .

Hospital representatives convened today in Chicago to discuss strategies for accelerating their improvement in the six Campaign interventions. The 70+ attendees included Nodes from the upper Midwest and caregivers who trekked from northern Indiana and southern Illinois.

The meeting began with remarks from Leonard Lamkin of the Chicago Patient Safety Forum and Dr. Lee Sachs of Advocate Health Care, who generously welcomed us to his facility for the day. A new Campaign video led into Campaign Manager Joe McCannon’s keynote speech on Spread and Sustainability, which provided helpful tips for hospitals looking to implement changes throughout their entire facility or system. After the presentation, Joe and IHI Director, Betsy Lee, did a great job of fielding many questions about the next phase of the Campaign and its alignment with future national improvement initiatives.

While hospital representatives broke into discussion groups for their respective interventions, the Nodes met to discuss opportunities for ongoing collaboration. Tom Evans, from the Iowa Healthcare Collaborative, did a great job of facilitating. By the end, it was clear that the potential for peer-to-peer learning within the Node Network was nearly inexhaustible. There is also talk about convening a second session of this type before the end of the year.

The success of the meeting was a testament not only to the commitment of Midwestern hospitals to improving patient safety, but also to a growing level of anticipation for the next phase of the Campaign.

Tom Evans from the Iowa Healthcare Collaborative leads a meeting of Midwest Nodes (joined by Campaign Manager, Joe McCannon, and Central Regional Field Coordinator, Jonah Borrelli) in Chicago.

The Campaign’s “National Infrastructure for Change” continues to grow and solidify as a flurry of Node collaboration sweeps across the country. On June 26, the Western Region Alliance for Patient Safety (WRAPS), a group consisting of the California, Arizona, Nevada, Utah, Colorado, New Mexico, Wyoming and Utah Nodes, convened their second in-person meeting in Denver. Our sincerest thanks go to Laurel Petralia of the Colorado Trust for hosting the meeting! Attendees discussed their experiences as Nodes, identified opportunities for sharing resources, and continued to explore the issue of standardizing hospital wrist bands. Recognizing that Nodes have much more to gain by working together than separately, this group has hit the ground running, and they continue to dazzle the Field Team with their on-going support of each others’ efforts.

On July 19, IHI hosted in our Cambridge office a Northeastern Regional Node Meeting, which included representatives from Connecticut, Massachusetts, Rhode Island, Vermont, Maine, New Hampshire, Pennsylvania, New York, and New Jersey. At that meeting, the Nodes shared best practices and offered insight on how we could improve the Node Network. Maureen McKee, of the New Jersey Council of Teaching Hospitals, offered to help moderate this group’s communications and progress, and we appreciate her stewardship of this emerging group.

Thursday, June 1, 2006: “Collaboration” is the watchword in San Diego
Members of the Campaign team and California Node participated in a string of hospital visits and meetings in San Diego today. The University of California San Diego Medical Center (UCSD) hosted us at a town hall forum that attracted over 70 participants. We learned about their progress on all six Campaign interventions and their participation in a field STEMI collaborative to reduce their “door-to-balloon time,” as well as another collaborative to improve the implementation of Rapid Response Teams. By engaging the health care community, UCSD and other San Diego-area hospitals are able to accelerate each others’ efforts.

Kaiser Permanente San Diego also treated us to a visit and we met with members of their medical staff, quality department, and frontline teams. They shared some of the secrets to their success and we imparted whatever wisdom we could to support their robust efforts in reducing nosocomial infections. At Sharp Grossmont Hospital, we met with another large group of committed and engaging hospital leaders. This enthusiastic bunch even stayed until 6 PM on a Friday afternoon! Their culture was highly supportive of their quality initiatives and I expect their early successes in reducing AMI mortality and VAP will spread to all six Campaign areas.

The team from Kaiser Permanente San Diego with IHI Director, Fran Griffin, and Gabe Kleinman and Matt Louchheim of the Campaign Field Team.

The Campaign Field team just returned from a whirlwind 2-day tour of the Portland area, where lots of great work is going on – including some shining examples of the power of collaboration. Representing IHI: Matt Louchheim, Field Coordinator, Western Region; Frank Federico, IHI Director and expert on Medication Reconciliation; and yours truly, Jane Roessner, IHI Publications, on the lookout for great stories about work on the front lines of the Campaign. Our Portland hosts and guides were Leslie Ray (awesome host, but don’t ask her for directions!) and Jim Dameron from the Oregon Patient Safety Commission, and Stacey Aguas from OMPRO.

Day One kicked off with a meeting of the Citywide Medication Reconciliation Group, including pharmacists, physicians, and quality managers representing most of the hospitals in the Portland metro area – all working together to share lessons learned and get advice overcoming barriers – a great homegrown example of collaboration. The group had lots of questions for Frank: e.g., “Is it necessary to reconcile medications every time a patient is transferred?” “What about when physicians are asked to order medications they’re not familiar with (for example, the orthopedic patient on cardiac meds)?” “How do you get physicians to comply with the Med Rec form?”

And Frank had some basic advice to the group:

1. Use small tests of change.

4. Don’t worry about getting the “perfect system”; just start testing!

Next stop: Kaiser Sunnyside, where “Calling the CAT” -- the Rapid Response Team, short for “Critical Assessment Team” – is saving lives. Great work also in reducing central line infections (zero cases in 4th quarter 2005) and VAP (zero cases in Q4 2005).

Last stop of the day: Providence Milwaukie Hospital, where a strong interdisciplinary team, including physician champions, the CFO, the CNO, informatics and pharmacy, is using Six Sigma methodology to make great progress in Medication Reconciliation. Great tip for getting buy-in from resistant doctors: “Try using this form three times” – then tell me how you feel. (IHI team wrapped up the day with dinner in The Pearl and – of course -- browsing Powell’s Bookstore.)

Day Two began with a visit to Legacy Emanuel, which is doing great work on Med Rec, led by a physician and pharmacist. For VAP and CLI, they’re harnessing the power of non-compliance data: showing the cost, in lives and dollars, of even a small percentage of failure to comply with all bundle elements.

Next stop: A Town Hall Meeting moderated by Oregon Node leader, Gwen Dayton of the Oregon Hospital Association, drawing an audience of leaders from the greater Portland metropolitan area, was a free-wheeling Q&A session with lots of curiosity about the Campaign (What happens after June 14? What would IHI do differently if it could do it over?)

Next, we headed for the hills – a beautiful drive up to OHSU, the Oregon Health & Science University nestled high in the hills to the west of Portland, where the hospital is working hard on all six Campaign interventions. Around a huge conference table, some 40 people – including the CMO, the CNO, physicians, quality managers, and others – described their tests and successes, and picked the brains of their IHI visitors.

Great visit, packed with learning, most importantly: Oregon hospitals are shining examples of working aggressively, creatively – and, above all, collaboratively – to implement the Campaign interventions and make care what it should be for all patients.

Monday, February 27, 2006: The inaccurately named "spring" tour hits the road!

With June fast approaching, the Campaign team is braving the winter’s cold and blazing yet another trail across the country, meeting with hundreds of hospitals and supporting the activity of field offices (Nodes) wherever we go. In the last three weeks alone, we’ve visited Houston, Dallas, Cleveland, Milwaukee, Chicago, Philadelphia, Long Island, Anchorage, Las Vegas, Miami, Phoenix, Tucson, South Carolina, San Francisco, and Orange County, California, and we ought to be coming your way anytime now. Highlights from the road:

-- A visit to the Palmetto Health System in Columbia, South Carolina, where we learned that their flagship facility had gone over a year without a ventilator-associated pneumonia.

--Incredible AMI success for Aurora in Milwaukee. Door-to-balloon times as low as any others we have seen…ever!

--Central DuPage Hospital in Winfield, IL has achieved VAP rates for infants that fall into the top 10th percentile globally and ventilator days have been reduced by almost half since January 2004.

--Midwest Field Coordinator, Jonah Borrelli (a/k/a "the new guy"), rallied Bob Lloyd and the Wisconsin Node to search for some choice eats in Milwaukee. After examining a number of options, they decided on Louise’s in neighboring Brookefield. The moderately-priced Italian fare and variety of fine wines afforded the travelers a better night’s rest than even the finest Milwaukee Polish sausage and Pabst Blue Ribbon could have done.

-- Great success at St. Jude Hospital in Fullerton, CA in launching their Rapid Response Teams. Unfortunately, they did have one unintended consequence to report: due to the significant decrease in code calls outside the ICU, their crash cart has begun to collect dust!

-- Kaiser Permanente in Orange County has gone three quarters without a blood stream infection in their ICU. IHI faculty member, Kathy Duncan, and Matt saw that the entire hospital was very engaged in the Campaign and eager to learn.

Matt Louchheim at the Long Beach Memorial 100,000 Lives Campaign lunch with frontline teams, physician champions, and leadership

-- Long Beach Memorial Hospital organized an action-packed visit that included a banquet lunch. With their leadership and medical staff committed to the Campaign, this hospital is well on their way to great achievements.

-- Matt finally introduced Kathy Duncan to the famed In-N-Out Burger. Hopefully, the word will spread, so he can lure more IHI Faculty out West!

-- A really awesome Rapid Response Team at UHHS - Richmond Heights Hospital in Ohio. They've reduced their mortality rate by nearly 50%.

-- Another great Rapid Response Team implementation at North Shore Hospital in Miami. They call it the “Rapid Assessment Team” or “the RAT.” They've had fun with the rodent theme (think rat-shaped gummy candy!) and the hospital has had great success as a result.

-- Strong results all around at Providence Alaska Medical Center in Anchorage. Their CMO is also a fantastic and very engaged leader.

-- Also in Anchorage, Matt and Alexi spent Valentine's Day dinner at Humpy's, a great pub in downtown. They even played the pub quiz and rocked the "Ask the Doctor" round, answering all the questions correctly!

Alexi and Matt with the team from St. Rose Dominican Hospital – Siena in Henderson, Nevada

-- Over a year of no VAPs at St. Rose Dominican - Siena in Henderson, NV and over 18 months VAP-free at their cross-town sister facility, Rose de Lima.

-- Outstanding teamwork and complete involvement of all stakeholder groups (leaders, physicians, surgeons, nurses, respiratory therapists, etc.) at Sunrise Medical Center in Las Vegas has led to outstanding results in several of the Campaign interventions.

-- Lots more fun in Vegas, but what happens in Vegas stays in Vegas, so, unfortunately, we're obligated to keep Matt's birthday escapades under wraps!

Our general impression is that something remarkable is happening in American health care as a result of the heroic, sustained efforts of the thousands of hospitals taking part in this Campaign. The errors, infections, and catastrophic events that harm and kill thousands of Americans are on their way to becoming history. We have to push on until June 14th - and beyond - but our deep hope is that we can make this progress permanent.

Thanks, as always, for all that you are doing to introduce the six Campaign interventions in your hospitals.

- Joe McCannon and the Campaign Field Team

Friday, December 30, 2005: Aloha from Hawaii!

Hau’oli Makahiki Hou (Happy New Year) from the Big Island of Hawaii! While visiting family for the holidays, I had the privilege of visiting the North Hawaii Community Hospital (NHCH) in Kamuela and meet its gracious Performance Improvement Leader, Lauraine DuPont. Being small is a virtue at this 40-bed hospital. NHCH have become agile champions of health care quality, working for several years to reduce ventilator-associated pneumonia and central line infections. In fact, they have not had a catheter-related blood stream infection in over four years! Their work in AMI is also praiseworthy. NHCH is the first hospital in Hawaii to receive the American Heart Association’s Get with the Guidelines (http://americanheart.org/presenter.jhtml?identifier=3013897) Performance Achievement Award for Coronary Artery Disease. According to Ms. DuPont, the key to success is a C-Suite that supports quality initiatives and a medical staff eager to implement.

- Matt Louchheim

North Hawaii Community Hospital's CEO, Stan Barry, and Performance Improvement Leader, Lauraine DuPont, with the Campaign's Western Field Coordinator, Matt Louchheim.

Monday, December 19, 2005: Post-Forum Campaign update

I'm just back from IHI's National Forum and feeling very exhilirated by what we witnessed there. A record 5,500 individuals were with us and excitement about the 100,000 Lives Campaign was infectious. In his plenary address, Don Berwick gave an update on our progress: 3,000 hospitals enrolled, a powerful national network for change in place, and – by our current estimate – over 30,000 lives saved to this point by hospitals participating in the Campaign (see the PowerPoint presentation from Don's talk here http://www.ihi.org/NR/rdonlyres/2E66202E-880A-4F7C-AC4A-57EA8BA0B50F/0/Forum2005PlenaryFINAL.ppt). We're seeing superb results for every intervention in every type of hospital and I encourage you to seek out peer organizations that have made early strides through our growing Mentor Hospital Network. Please also make use of the action lists for each hospital stakeholder group (leaders, managers, and frontline teams) posted on the Campaign website (essentially "to do" lists for the coming months), http://www.ihi.org/NR/rdonlyres/A63FE39F-1FE7-47F8-85CD-42F2D1E5A832/0/StakeholderActivityChecklistFINAL.pdf.

The take home message: the Campaign team left Orlando with inspiration and a great sense of optimism. We have a lot to celebrate and, with continued commitment and hard work, we have a real chance at saving 100,000 lives. A six-month spring to the finish line begins NOW!

Happy Holidays!

- Joe McCannon

This space has been uncharacteristically quiet since the Campaign team returned from its coast-to-coast Bus Tour in mid-October and I apologize for that. With barely a minute to catch our collective breath, we leapt into November with a series of meetings, call-in shows, and Node activities.

The highlight was a fabulously successful “National Open House Day” on November 3 which consisted of multiple calls on each of the Campaign interventions, attended by hundreds of participating hospitals who called in to connect with experienced peers and experts. We’ve also spent a great deal of time processing everything we’ve learned in the last 11 months and shaping our strategy for the home stretch of the Campaign.

This all starts with IHI’s National Forum meeting next week, the organization’s flagship event which will have as many as 5,000 attendees coming together to learn more about improving health care from global authorities and fellow providers. The plans for the Campaign’s next six months will be laid out in some detail there and the Campaign team will introduce several new resources – including a national network of mentor hospitals and action lists for all hospital stakeholders (Boards, executives, managers, providers, etc.) – to support ongoing change.

After a short pause for the holidays, we intend to burst into the New Year by leaving the friendly confines of Cambridge to engage directly again with the courageous Nodes, systems and hospitals taking part in the Campaign, visiting the front lines where great change is happening.

I’ll be back after next week with a post-Forum update.

Friday, October 14, 2005: The Bus Tour concludes in Seattle

After 4438.2 miles of driving, we finally dipped our feet in the Pacific Ocean (well, not really, but doesn’t it sound so poetic?) and completed our 100,000 Lives Campaign Bus Tour. Words cannot describe the excitement all of us are feeling now.

Yesterday, we ended the wildly successful tour with a wildly successful Regional Node Meeting in Seattle. We had representatives from our Nodes in Washington, Oregon, Alaska, California, Providence Health System, and elsewhere. It was a vibrant mix of people and organizations in the magnificent Odyssey Room overlooking Puget Sound. We explored a variety of very important issues including the crucial role of data in the Campaign and alignment of the Campaign with other national initiatives. As in all the tour’s Node meetings, we learned a lot, and we’ll be putting our thoughts together and sharing it with all of you very soon.

The Campaign Bus Tour – after months of planning, hundreds of hours of hard work, 15 cities, 19 hospital visits, and 5 regional node meetings – is finally complete. It goes without saying that this was a massive team effort. There are so many people we need to thank for making this crazy idea a reality – and a successful one at that. Warm thanks are due to the many IHIers who bravely boarded the bus at stops along the way; to the IHI Management Team for their strong support; and to Don Berwick, Maureen Bisognano, and Joe McCannon for their bold leadership. Extra super special thanks goes to Matt Louchheim and Beth Meagher whose tireless efforts actually made this work! Our heartfelt appreciation goes to our bus driver, Hubert Butler, who – even as he helped us complete our nationwide journey – fulfilled a life-long dream of his own of driving cross-country. But the biggest thanks of all must go to the hospitals, Nodes, and Partners who welcomed us so warmly at every stop and whose outstanding work made the whole trip worthwhile.

- Alexi Nazem

[Editor’s note: Thanks must also go to Alexi Nazem, the Campaign’s Field Operations Manager, who spearheaded the bus tour and whose energy and enthusiasm for the Campaign has never waned – even after spending three weeks in an RV (I mean, a bus!)]

After an enjoyable detour in Texas yesterday (to join the Texas node as it reinforced its commitment to the Campaign) I rejoined the bus tour team in Seattle for the final two days of our nationwide odyssey.

We started this morning with a visit to the Washington State Hospital Association's (WSHA) annual meeting, pulling up to the waterfront at the Bell Harbor conference center and meeting many of the association's Board members to thank them for their terrific support in the state and update them on our progress in the rest of the country. (Later in the day, Don Berwick delivered a keynote address to gathered association members at the same site, and challenged them to continue to lead push for industry-leading results across the state. The energy in the room was very exciting and the focus on specific action items to support successful introduction of the Campaign interventions in the coming months set a dynamic tone.)

By mid-morning, we visited Swedish Medical Center where we were greeted by a terrific team who shared with us their outstanding work in introducing Rapid Response Teams and reducing infection throughout the Swedish system. Under the terrific physician leadership of Dr. John Vassal, the system's goal is to save 200 lives by December 2005, a full six months before the close of the Campaign and, by their estimates, they've reduced mortality by 66 lives already. The impact of the great work on staff satisfaction was also apparent, and a nurse's detailed story of her first interaction with the Rapid Response Team was especially inspiring.

In the afternoon, we visited Harborview Medical Center, which lived up to its reputation with one of the most spectacular views of the tour. Don joined the team on this visit and brought to bear the kind of star power that only an honorary Knight Commander of the Most Excellent Order of the British Empire can. We spent some very productive time speaking to front-line workers in the ICU, discussing the tools they had introduced in support of their intervention work, and hearing what tactics worked well in their implementations. Harborview, the only Level I Trauma center in 4 states and Seattle's "Safety Net" hospital, also acts as a communication hub for coordination of emergency care in the city, using a web-based application to identify openings in city hospitals and to direct ambulances to the appropriate destinations. All of this leads to an extremely active ED, and Carol spent a lot of time speaking to and learning from the staff there, discussing in particular how they were able to reliably apply the components of AMI care in their setting (which, despite their many responsibilities, they seem to have done very well).

We ended the day with a delicious Italian meal near the hotel, which was a nice treat for the field team (Alexi, Matt and driver Hubert), whom I had required – for budgetary reasons – to subsist on a diet of only gruel, rainwater, and, when they were especially good, rainwater-gruel. After the meal, Carol, Andy and I retired to our suites at the Warwick and Alexi, Matt and Hubert, bellies and hearts full, returned to their usual accommodations in the bus's undercarriage. Good job, team! I slept soundly that night in my gold-leaf pajamas and Andy reported that his "money bath" was extremely relaxing.

One more day left!

- Joe McCannon

There was something special in Boise when we arrived last night. Was it the late hour? The Idaho beer we had with dinner? The potatoes? The nearly three weeks of traveling in a bus? Whatever the reason, there was magic in the air, and we decided to see the bus in all its glory. After almost 20 minutes - with over 100 years of formal education between us – we finally figured out how to get the bus slide-outs to work. Sadly, while the newly cavernous interior was amazing, there was something oddly anticlimactic about the whole thing.

Anyway, to the real reason we came out here: our three hospital visits! Today, we had the privilege of meeting with the teams at St. Alphonsus and St. Luke’s in Boise and later at Holy Rosary Medical Center in Ontario, OR. In Boise, we were hosted at each hospital by an alum of the IHI Patient Safety Officer course. It was great to see some familiar faces out on the road.

At St. Al’s, we discussed the many different approaches to implementing Rapid Response Teams and some of the more fascinating details of the VAP and Central Line bundles. It was particularly encouraging to see so many committed doctors in the room. We are really seeing that having enthusiastic physician champions are a strong predictor of success in the Campaign.

St. Luke’s was equally fascinating. An enormous team gathered in their beautiful new facility to show off their strong results in preventing surgical site infections. It was obvious that they have a devoted team. And again, we heard about how physician championship drove their success. In their case, an orthopedic surgeon took up the cause and convinced his peers to join the effort.

At our third and final visit of the day at Holy Rosary in Ontario, we discussed a completely different set of issues: How do you execute the Campaign in a rural hospital? One thing was plainly obvious: Holy Rosary – and I suspect many other rurals as well – have the distinct advantage of agility and a tight-knit team that will allow them to be extraordinarily successful. Case in point, HRMC rolled out their VAP bundle implementation hospital-wide in less than two months.

In a couple of hours, we will have completed the driving portion of the tour. Can I get an “OH YA!”?

The Campaign bus tour visits the team from St. Alphonsus Regional Medical Center in Boise

After a great meeting in Denver yesterday, we embarked upon a harrowing journey through rain, sleet, and heavy snow through the Rocky Mountains of Colorado, Wyoming, and Utah. Big thanks are due to our intrepid driver, Hubert, who braved the elements during an incredibly long drive.

The brightest highlight of the journey west was definitely our visit to the lovely hamlet of Buford, Wyoming, which recently lost half its population, going from two people to one. Apparently the town was NOT big enough for the both of them. . . .

When we finally arrived in Salt Lake City this morning, we were greeted by the great team at University of Utah Hospital. We were also very excited to have IHI VP, Carol Haraden, and Campaign Data Guru, Andy Hackbarth, join the "bus team." The UofU team, led by Mo Mulligan, took us around to meet the frontline staffers who are making the Campaign interventions more than policies on a page. It was an excellent visit and we learned a lot from their very promising work on the critical care bundles.

Later, we took the bus further up the mountain to the George E. Whalen VA Medical Center, where we met with a newly formed (8 weeks ago) and very enthusiastic team working on the Campaign. They came ready with questions and luckily Carol was ready with answers! We had a wide-ranging discussion that focused on early data gathering and implementation. What most impressed us, however, was the receptive culture. Everyone was very open to trying new things. It was a welcome sight and one that is indicative of future success.

Off to Boise. . . .

Monday, October 10, 2005: Learning from urban and rural hospitals in the Campaign in Colorado

After spending a restful weekend in the Denver area, where we enjoyed 80-degree weather, the Bus Tour was hit with its first snow storm. At the same time, Jason Reed, 100K Lives Project Coordinator, arrived to join the bus tour. Coincidence? I think not. Fortunately, we were given shelter by the good people at Denver Health and the Colorado Trust, who warmed us with their hospitality and dedication to improving the quality of health care.

Dr. Patty Gabow and Dr. Philip Mehler were our gracious hosts at Denver Health – they demonstrated that executive leadership can produce real results in the face of great challenges. Not only does Denver Health provide $1.4 billion in care for the uninsured – constituting 42% of all unsponsored care in metropolitan Denver – they also report very low acute care inpatient mortality (compared to the national average) and have not had a case of Ventilator-Associated Pneumonia in nearly six months.

Later, the Colorado Trust hosted the regional node meeting, which attracted Campaign participants from Colorado, Wyoming and New Mexico. We spent much of the time developing strategies for the rural hospitals enrolled in the Campaign. We plan to share all we’ve learned more widely upon the tour’s conclusion. Until then, onward ho!

After a brief detour to the wrong hospital, Kathy Duncan, Alexi Nazem, Joe McCannon and I arrived at St. Francis Hospital in Topeka, Kansas. There we met with teams from St. Francis and Stormont-Vail Hospital, which is located right across the street. They had split up into two groups – one focused on Rapid Response Teams and the other on preventing VAP. Luckily, we had Kathy, our trusty Rapid Response Team expert, with us. St. Francis and Stormont-Vail are the only 2 hospitals in Topeka, so it was great to see them collaborating.

After the meeting, Alexi, Joe and I headed back to the bus for our eight hour drive to Denver. The drive was…well…flat. The highlight of the drive had to be the world’s tallest easel in Goodland, KS. And it was a 2 for 1 package because on top of the world’s largest easel is the world’s largest Van Gogh replica! It was a breathtaking sight and one that I’m not sure can be topped.

Only one week to go!

Today the bus rolled into St. Louis for our Midwestern regional node meeting. Alexi Nazem, (Campaign Project Manager) Joelle Grande, Joe and I were joined by IHI faculty members Kathy Duncan and Tom Evans. Katy Dowd, from IHI’s marketing department, was also kind enough to take time out of her vacation to lend support to the bus tour. Several of the state nodes were in attendance as well as many of the large system nodes participating in the campaign such as Ascension, Tenet, and SSM. These system nodes provided a unique perspective on how they are able to support their hospitals with implementation. We learned that leadership was very engaged at these organizations which helped to drive their success. We also got great ideas on how to teach improvement methods on a large scale. All participants agreed that continued collaboration on a regional level would be useful – hopefully this leads to many more meetings such as this one. Now it’s off to the great plains of Kansas!

The hosts of the Midwestern Regional Node meeting welcome the Campaign Bus Tour's arrival in St. Louis

Wednesday, October 5, 2005: The Journey Continues - a warm welcome in Chicago and Downer's Grove

This is Joe McCannon as we blaze through the fields of southern Illinois to make our St. Louis node meeting. The bus trip itinerary has been intense at times, but it also continues to be incredibly rewarding. The energy we’re witnessing is very real and, beyond drawing attention to our cause (witness a packed press conference at Northwestern Memorial Hospital in Chicago today), we’re learning a tremendous amount about what works for hospitals and what doesn’t as they implement the key interventions of the Campaign. Capturing this information and converting it into a program of work for the coming months will be job one when we return.

Early this morning we headed over to Northwestern Memorial Hospital to hear from their leadership and teams working on the Campaign interventions about their great progress to date and their ongoing improvement work.

And in the afternoon, we had a great visit at Advocate Good Samaritan in Downer’s Grove (a western suburb of Chicago). They prepared a terrific agenda that included a welcome from scores of cheering staffers (complete with “Eye of the Tiger” blaring over loudspeakers!), impressive presentations on each intervention and a tour of the ICU.

Chicago is also the home of many of the Campaign’s key national partners – among them AMA and JCAHO – and strong local nodes – like the Chicago Patient Safety Forum – who stood with us at the press event and who continue to give us the energy we need. We're so thankful for their continued support.

Balloons, pom-poms, banners, and cheers greeted the Campaign Bus Tour as it arrived at Advocate Good Samaritan Hospital in Downer's Grove, Illinois.

Hi from Maureen Bisognano (IHI Executive VP and COO), checking in from the Campaign Bus Tour. We met here at Indianapolis Heart Hospital, part of the Community Health Network, and the bus rolled in to cheers from dozens of physicians, nurses, and other leaders who have been working for decades to improve care. They got lots of energy from the Campaign Team and we got the same from them!

We held a press conference under sunny skies and then met with the system's leaders, both front line and senior, in a great strategy session. The nodes, including the Indiana Hospital and Health Association and the QIO, Healthcare Excell, joined VHA in support of the great work now happening in Indianapolis.

We learned that one of their CCUs has gone for 25 months without a VAP! The progress shared is so heartening; it is clear that we can reach our goals if can get all to make this level of improvement! The group also challenged us with the barriers they are encountering and we spent a wonderful session working through front-line issues.

The whole group joined Madge on one of our 100K LIVE! calls and the enthusiasm was just great. The road is a great place to be...the results are here!

I brought the Team on the bus (Alexi, Beth, and Matt of the Campaign Field Team; Project Manager, Joelle Grande; and IHI Director, Frank Federico) Red Sox "Again!" bracelets to get them in the spirit and Boston candy and cookies to remind them of home. All were grateful and happy (except Alexi...the Yankees fan!)

- Maureen Bisognano

Monday, October 3, 2005: DC celebration of the national infrastructure to improve patient care

"Collaboration," says Steve Jencks of CMS, that's what distinguishes what's happening now with quality improvement in US hospitals, compared to before. Jencks, the Senior Quality Advisor for the Centers for Medicare and Medicaid Services, credits IHI and Don Berwick's vision to launch the 100,000 Lives Campaign, as the big reason more hospitals than ever before are focusing like a laser on better patient care. But today, looking out at all those gathered in the plaza outside the Reagan Convention Center in Washington, DC, it's clear that many, many organizations — CareFirst, Delmarva, the Maryland Patient Safety Center, CMS, ANA, AHA, and all the representatives of Nodes who traveled to DC from along the Eastern seaboard to meet and work with one another — all these forces now share the ownership and momentum and leadership that will drive change at hospitals and help the 100,000 Lives Campaign succeed. What's already evident from the bus tour: no one is about to drop their engagement with these issues in June 2006.

It was a gorgeous fall day in DC, the bus is holding up fine and still makes for a fantastic backdrop wherever it's parked, and the team is as enthusiastic as ever and energized by the health care improvers they're encountering along the route. There was a very successful regional node meeting this afternoon, with dozens of terrific suggestions for how to better match the needs of mentor hospitals with those in needs of their tools and expertise. On to Indianapolis.

The “100,000 Lives and Beyond” Launch in Washington, DC (pictured left to right):
Steven Jencks, Senior Quality Advisor, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services; Maulik Joshi, President and CEO, The Delmarva Foundation; Don Berwick; Linda Stierle, CEO, American Nurses Association; David Wolf, Executive Vice President, CareFirst Blue Cross Blue Shield; and Richard Davidson, President, American Hospital Association

Friday, September 30, 2005: Bus Tour Day 5 in Delaware

Howdy from Wilmington! Today the bus – along with Kelly McCutcheon Adams, Jo Ann Endo, Beth Meagher, and me – rolled into St. Francis Hospital, a member of the Catholic Health East (CHE) system. St. Francis’ Campaign team greeted us warmly at the door and – led by Patricia Winston, VP of Patience Care Services/Chief Nursing Officer – we quickly started our discussion.

St. Francis has focused on the SSI intervention and they are beginning to see great results. We were blown away by their mastery of the Model for Improvement. They have engaged in multiple small tests of change and have already seen their quality improvement efforts spread beyond their pilot area.

We were also impressed as Diane Denny, VP of Quality and Patient Safety, described CHE’s “Human Face of Safety” collaborative, which includes the use of a “portal” to share information online. The portal is primarily a monthly data reporting repository, but also hosts discussion forums, posts tools that can be shared, and fosters an online community to encourage collaborative learning. It was music to our ears when Diane described their “all teach, all learn” philosophy.

After a very productive discussion, the St. Francis team took us on a tour of their newly renovated and expanded ED. The improvements they’ve made here – including an electronic medical record system and the placement of their cardiac cath lab on the same floor – will no doubt be helpful when they eventually implement the reducing ADEs (medication reconciliation) and the AMI interventions.

After the tour, our gracious hosts sent us on our way back to our beloved Interstate 95. They even gave us “party favors,” which included bottles of Delaware champagne (non-alcoholic, of course, since we’re driving in a bus!).

We left Wilmington energized by St. Francis’ great work and their enthusiasm for the Campaign. We hope that everyone can emulate their model.

We’ll check back in from DC . . .

- Alexi Nazem

St. Francis Hospital in Wilmington prepares a warm send off for the Campaign team.

Thursday, September 29, 2005: Another exciting stop, this time in New Jersey

This is Jo Ann Endo, IHI Communications Specialist, still buzzing from a visit to Princeton. Our time in New Jersey provided further evidence that this bus tour is an excellent way to learn a lot about what’s really happening with Campaign implementation.

Today’s first stop was with the New Jersey Council of Teaching Hospitals (NJCTH) at the luxurious Jasna Polana Golf Club, a former mansion with a colorful history. (Joe said it reminded him of his “summer home”!) The CEOs from New Jersey’s teaching hospitals welcomed us at their board meeting. Deborah Briggs, NJCTH’s Senior Vice President for Health Policy & Advocacy, talked about how they – as the New Jersey Node – have provided a variety of supports to hospitals in the Campaign, including workshops, monthly team meetings, and conference calls. One of their most impressive offerings is a massive set of Implementation Tool Kits. These binders compile not only all of the IHI materials, but also additional articles and resources. They could call them “Implementation Bibles”!

In the afternoon, we drove to Robert Wood Johnson University Hospital Hamilton to meet with representatives from many of the state’s hospitals. They were both candid in describing their struggles and enthusiastic about the Campaign. Many of those in attendance were QI veterans and we were pleased to hear them say the Campaign has helped reinvigorate their quality improvement efforts.

More than once, we heard about the challenge of engaging some physicians. In response, we referred them to the AMA’s Making Strides in Safety Campaign tool kit which is designed to encourage physician leadership in the 100,000 Lives Campaign. In addition, we stressed the importance of identifying physician champions who can connect on a peer-to-peer level with skeptics.

It was also great to hear about the New Jersey hospitals’ successes. Anne Dikon, RWJ Hamilton’s Infection Control Coordinator, reported they went for eight months without a VAP and five months without a CLI. IHI Director, Kelly McCutcheon Adams, noted that these outcomes signal a significant change in hospital culture. She pointed out that it was not so long ago that many of us just accepted such hospital-acquired infections. Now we want to get to the bottom of a single case!

I can’t wait to see what we learn in Delaware!

Wednesday, September 28, 2005: A Philadelphia area visit to two Campaign hospitals

Hi, this is Beth Meagher, Eastern Field Coordinator for the 100K Lives Campaign. Today, we had a wonderful day in Philadelphia and were able to visit two great hospitals participating in the Campaign. First thing in the morning Alexi and I headed to Abington Memorial Hospital, right outside of Philadelphia. We were met there by Lindsay Swain and Carrie Peck, IHI Project Managers and Marie Schall, IHI Director. After a brief tour of their beautiful new wing we got down to business. Abington is participating in all 6 interventions and is being led by their very proactive chief of staff, Dr. Kelly. We heard from physician and nurse champions successes of and barriers to each of the interventions. They are extremely committed to the work of the 100K Lives Campaign and it was apparent how important champions are to its success.

In the afternoon we visited the Children’s Hospital of Philadelphia. This visit was particularly informative for us regarding the challenges that pediatric hospitals face within the campaign. They are working on all interventions, excluding AMI, but are particularly focused on central line infections. Their results have been fantastic so far and they are focused on continuing this success. It was so great to see the enthusiasm of the teams in these hospitals. These visits have definitely refueled our tanks for the drive to New Jersey!

Day Two of the bus tour and I am thrilled by the energy and support we've seen thus far. While our means of transportation is drawing some wonderful attention (and the occasional puzzled look), I am more clear than ever that this journey is not about the bus. The bus is simply a vehicle (pun intended) to bring us to the health care providers who are doing such important work and allowing us to share their stories with the rest of our national network.

We started early this morning with a visit to Metropolitan Hospital, part of the New York City Health and Hospitals Corporation, a system of public hospitals in all five boroughs that includes 11 acute care facilities participating in the Campaign. Don Berwick spoke to representatives from across the system who were gathered at Metropolitan to deepen their work on reducing surgical site infections. The energy in the room was quite moving and the desire of the providers there to provide top-notch care under challenging circumstances was palpable.

Next, we held a press conference with representatives from the New York field office ("node"), a tremendous network that includes almost every major health care stakeholder in the state. They are giving New York hospitals tremendous support in the form of meetings and collaborative activities and materials, and they identified new ways to sustain their efforts in order to see life-saving results from every hospital in the state. (Over 90% of acute care facilities are already enrolled). The AMA — a key partner from the outset — also reaffirmed its partnership with IHI in this vital work.

Skipping lunch, we headed to a meeting of the quality committee of the New York-Presbyterian Healthcare System, whose leadership has shown an extraordinary commitment to the Campaign and implementation of its six interventions. Accountability systems are in place to ensure high performance and the system's leaders generously offered to act as mentors to other hospitals in the state.

One of today’s highlights was our trip to Weill Cornell’s MICU, where we met Assistant Nurse Manager, Chip Holmes. Chip and his team are working hard to reduce central line infections with the help of a New York City CLI collaborative. Weill Cornell’s MICU is using a great cart with a CLI bundle checklist and all the necessary materials for inserting a central line safely. We tried to take a photo of Chip with his cart, but our camera’s battery died! Anyway, I assure you that Chip was sporting a big smile.

Last, but not least, we also officially announced today that we eclipsed 2,800 hospitals enrolled in the Campaign nationwide — not too shabby. After today, I just wish we could visit all of them.

Daniel Sisto, President of HANYS, welcomes Don Berwick and the 100,000 Lives
Campaign Bus Tour to a press conference at Metropolitan Hospital in New York City.

The Campaign Bus Tour is off to a great start!

This is Laurel Simmons, IHI Grants Director/Project Director, and I’ve just spent the morning on the bus tour. After a send-off from the IHI staff in Cambridge, the Campaign bus made its way to the Sheraton in Lexington, MA where we had a great meeting with the Massachusetts, New York, Connecticut, Rhode Island and New Hampshire nodes. Joe and Alexi facilitated a great conversation and asked what the nodes needed to support implementation. They requested information and tools that health care leaders (hospital boards and trustees) could use to monitor progress and support their hospitals. For example, they had the idea of creating a “dashboard” that hospital boards could use to know what measures they should be tracking. They also talked about creating a “New England Node Network” so they could keep talking with each other.

What was amazing for me was to see how real this is for so many people. It’s clear how central the Campaign is for IHI, but I’d never had a chance to see how it’s become what health care leaders are talking about with their constituents. I also didn’t know that every acute care hospital in Massachusetts has signed up for the Campaign — 100%! I look forward to hearing more as the bus tour makes its way to New York.

IHI President and CEO, Don Berwick, joins the
100,000 Lives Campaign team at the launch of the bus tour.

It's the night before we head out "on tour" with the 100,000 Lives Campaign bus and excitement is running high. Our bags are packed — actually, Alexi might still be packing! — and we're looking forward to hitting the road and drawing attention to the amazing energy for improvement in American hospitals and the national infrastructure that's being built as a result of the work going into the Campaign.

Having traveled to many nodes this summer, we know that getting out in the field and meeting people in person is the best way for us to learn from Campaign participants and the nodes about how we can help celebrate their successess and troubleshoot the problems they face. As we fast approach the half-way point in the Campaign, we know we aren't going to meet our goal for mortality reduction unless we're serious about creating a nationwide learning system that will drive real change. I sincerely hope that this bus tour will help accelerate this process.

We'll be posting blog entries from every stop along the way, so please check in often for the latest!

Another state, another absolutely amazing Node! I bore witness to one of the most inspiring displays of commitment to saving lives today. The Wisconsin Node launched their work in the Campaign at Camp Randall Stadium in Madison, home of the University of Wisconsin Badgers. To demonstrate the huge impact the Campaign will have on the citizens of Wisconsin, the Node used yellow balloons to rope off three entire sections of the stadium, representing the 6,000 people the Campaign intends to save from avoidable hospital deaths. (I guess it’s going to be that much harder to get a ticket to the football games this season!)

Here’s the team that’s going to help make the Campaign a success in Wisconsin. The 6,000 seats surrounded by yellow balloons represents the number of people Wisconsin has pledged to save by implementing the Campaign.

Hello from 110-degree Arizona. Matt and I had quite the action-packed day today in Scottsdale. Thanks to Barb Averyt for putting together an awesome agenda. We kicked off the day at the launch of the statewide “Safe & Sound Initiative,” which aims to prevent medication errors in Arizona by promoting the use of a standardized, patient-carried medication list. (You can download the form for free at www.themedform.com.) We spent the rest of the morning with hundreds of quality staff and frontline providers from around the state and their enthusiasm for the work and for the Campaign was palpable.

In the afternoon, we went to visit the folks doing amazing improvement work at Scottsdale Health’s Osborn campus. We met with the team working on reducing Surgical Site Infections. Everyone working on preventing SSIs can learn a lot from them. We also got to chat with the ICU team about their efforts to prevent VAP. They told us how – to ensure compliance with all VAP bundle components – they now include bundle checklists in every patient chart. They also gave us a tour of their new digs, one of the most beautifully designed ICUs I’ve ever seen. I’m sure it’s because the staff were involved in every step of the design process.

Alexi and Matt of the Campaign team with Barb Averyt of the Arizona Hospital and Healthcare Association at the Safe & Sound kickoff.

The Colorado Node launched their state’s participation in the Campaign today at the Denver Center for Performing Arts. The sponsor of the event, the Colorado Trust, is providing grants to each of the Colorado hospitals participating in the Campaign. Sixty-one of the state’s 71 acute care hospitals have committed to the effort and they were represented in full force at the launch. Nearly 200 people attended the function, which was held in a ballroom with a panoramic view of the Denver skyline. IHI Senior Fellow, Jim Conway, remarked that the stunning view offered unfair competition to his address on the role of leadership in the Campaign. I could attest, however, that his concern was entirely unfounded – his dynamic and insightful talk ensured that everyone remained engaged throughout his presentation. Don Berwick also made an appearance via video, but his impact was far from virtual. We also learned about best practices in AMI care and Rapid Response Teams from Dr. Mori Krantz from Denver Health and Hospitals, and Jane Braaten and Deborah Smith from Centura Health, respectively. With these leading examples, and the ongoing support and technical assistance from the Colorado Foundation for Medical Care, this effort is well on its way to saving lives in the heart of the Rockies.

What a day! I just had the most amazing time at the launch of the Kansas Node. The University of Kansas Hospital at KUMC, one of the first 10 hospitals to sign up for the Campaign, was kind enough to host us for the day and to share some great stories of their work on the Campaign. We spent the morning in an informational session for the press and hospital staff from around the state. The turnout was spectacular and several media outlets covered the event.

The highlight of the day was by far hearing the story of Mrs. Jennifer McClanahan, a woman whose life was saved due to the intervention of KUMC’s Rapid Response Team. Mrs. McClanahan spoke eloquently about her journey and profusely thanked the team that saved her life. She vowed to stick to her cardiac rehab regimen and vowed to live her life with that much more zest so that the rapid response team’s work was not in vain.

Mrs. McClanahan, second from left, her daughter Jennifer Owens, far left, and the KUMC Rapid Response Team that Mrs. McClanahan credits with saving her life.

I had a great visit to beautiful Helena, Montana today to say a few words about the Campaign at the Board meeting of the Mountain-Pacific Quality Health Foundation. Mountain-Pacific is the Quality Improvement Organization (QIO) for Montana, Wyoming and Hawaii (as well as Guam, Northern Marianas and American Samoa) and they’ve made a terrific commitment to act as one of our Campaign nodes, supporting implementation of the Campaign interventions in these areas. The conversation after my presentation was very helpful and those present seemed resolved to jumpstart support activities for their constituents. One particularly important recommendation was to explore the financial impact of introducing the Campaign’s six interventions. (This idea is in the works and will hopefully be addressed in a national conference call in the coming months). I also heard some very interesting ideas about how to engage office practices and address the needs of rural facilities (this thinking will contribute to our growing partnership and programming with the National Rural Health Association). Thanks to Janice, Jack, Penny, Carole and everyone in attendance for having me!

(Of no small importance, I also had what has to rank as the best dining experience so far in the Campaign at the Helena airport. With apologies to the vegetarians out there, I enjoyed the tastiest burger I’ve had in a long time in the lounge across from the baggage claim. Five stars (out of five)!

Beth Meagher, our Eastern Region Field Coordinator, and I just had the privilege of spending the day with over 150 nurses, physicians, and quality improvement gurus from around Kentucky. The Kentucky Hospital Association (KHA), which is heading up their state’s Campaign Node, put together a fantastic educational program in Louisville – hosted at Jewish Hospital – on implementing Medication Reconciliation, reducing Ventilator-Associated Pneumonias, and deploying Rapid Response Teams.

After stirring welcomes from the KHA’s Michael Rust, Bob Shircliff and Lynn Simon of Jewish Hospital, and Kentucky State Senator Julie Denton, Heath Jennings from St. Joseph's Healthcare in Lexington described St. Joe's work on reducing adverse drug events through medication reconciliation. He also shared a variety of very useful tips on starting a MedRec program. Sherry O'Bryan from the Owensboro Medical Health System told the story of her ICU's journey to near total elimination of Ventilator-Associated Pneumonia. In fact, her unit hasn't had a single VAP for 7 months running! Finally, Joris Kramer told us about the great success Jewish Hospital has had with their Rapid Response Team. To learn more about the day's events and these stories, please get in touch with the Kentucky Node.

Beth and I came away from the day feeling like Kentucky Campaign hospitals are going to show us some great results!

Matt Louchheim here, reporting from the beautiful Pacific Northwest, where Alexi Nazem and I spent the day with the Washington node. At Seattle’s Mountaineering Club, we met representatives from the Washington State Hospital Association, Qualis Health, the Washington State Medical Association, the Northwest Organization of Nurse Executives, and the Service Employees International Union 1199NW. Already Washington has achieved one milestone – they have enrolled 100% of the acute care hospitals in the state! By setting this standard, we now hope other nodes are encouraged and will follow suit.

With the enrollment objective fulfilled, our meeting focused on developing strategies for implementation. We learned that hospitals are beginning to achieve notable successes. For example, Overlake Hospital Medical Center, in Bellevue, has implemented the Central-Line Bundle which has already reduced central blood-stream infections by 56% and saved over $150,000 in prevented healthcare costs.

Later that day, Alexi and I ran into Don Berwick, as he toured the halls of the Virginia Mason Medical Center. He delivered a couple of presentations on the 100K Lives Campaign (though we could only watch via satellite, since the auditorium was packed!) and the audience received him with enthusiasm. It’s too bad we can’t stay for much longer!

But with this trip near completion, we’re already gearing-up for our next one. We may be coming to a town near you!

Greetings from San Francisco! This is Matt Louchheim, Field Coordinator for the Western Region, reporting live from the kick-off of the Bay Area Patient Safety Collaborative. The collaborative is a new forum for hospitals in Alameda, Marin, San Francisco, San Mateo, and Santa Clarita counties, collaborating on the implementation of reliable, evidence-based practices to improve patient safety. Through the generous funding of the Gordon and Betty Moore Foundation and the coordination of the Hospital Council of Northern and Central California, the collaborative will initially focus on the six interventions that comprise the 100K Lives Campaign. There is plenty of hard work to be done, but based on their dedication and enthusiasm, today’s participants are undoubtedly up to the task.

The day began early – at 8:30 a.m., the hospitals’ CEOs convened to discuss the role of leadership in promoting patient safety. They were led in their conversation by Jim Conway, IHI Senior Fellow and former Executive Vice-President/COO of the Dana-Farber Cancer Institute. Afterwards, the CEOs were joined by other hospital executives and managers for a “nuts and bolts” review of the six interventions that took much of the day. IHI VP Carol Haraden pumped up the crowd with her straight-forward explanations, as Dr. Bruce Spurlock, the collaborative’s project manager, facilitated the conversation. The two were backed-up by Kathy Duncan (IHI Faculty), Lee Vanderpool (Dominican Hospital in Santa Cruz, CA), and Helen Macfie (St. Joseph Hospital in Orange, CA), who demonstrated that these interventions can be implemented and will lead to fewer deaths. The group also enjoyed a thoroughly entertaining keynote from Dr. Robert Wachter, Professor of Medicine at UCSF and Chief of the Medical Service at the UCSF Medical Center.

Thanks to the hard work of the people at the Moore Foundation and the Hospital Council we are one step closer to saving 100,000 lives!

Today Andy Hackbarth (a leader of the Campaign measurement team) and I had a fantastic visit at the offices of the North Carolina Hospital Association (NCHA) in Cary, NC. NCHA is leading the node for the state and brought together representatives from several of the over 100 hospitals that they have recruited to participate with us. After a few minutes of hot air from me, we had the great pleasure of listening as these leaders updated us on their progress, identifying barriers to introducing the 6 Campaign interventions and sharing their early success stories. Moderated by our friends Jeff Spade and Bill Pully, the conversation was vibrant and honest, yielding a lot of ideas about implementation (particularly for the Rapid Response Team and Adverse Drug Event/Medication Reconciliation interventions), guidance about jumpstarting change within the organization and suggestions about how IHI and Campaign nodes could help hospitals most (e.g. by offering advice on how to reconcile quality and safety priorities, and by providing more information on the business case for change). A highlight came when Cape Fear Valley Hospital noted a 47.8% reduction in codes outside of the ICU related to their recent implementation of a rapid response team – just the kind of change that keeps us thinking that our ambitious goal is really possible!

Thanks so much to our hosts for arranging the discussion and the food (Andy wasn’t shy about having two helpings)…on to the next node!

I'm writing to you from United Flight 882 on the tarmac of Chicago O'Hare airport...yup I'm delayed. We've been in the airplane in a holding area on the runway for about four hours and counting now. They've shown us two awful movies and served us a delicious meal of pretzels and soda. But the delay hasn't taken away one bit from how good I feel about my trip out here to the National Rural Hospital Performance Improvement Conference, where I had the chance to talk a bit about the Campaign and meet many people from rural hospitals participating in the Campaign. It was a lot of fun -- and very helpful -- to hear exactly what was going on out in the field and which challenges people were facing in implementing Campaign interventions in the rural environment.

On a related note, we are working to build a Rural Node to support rural and small hospitals in their work on the Campaign. We've enlisted the support of many rural hospital organizations around the country to help. Right now we are in the planning stages, but we hope to finish soon. (Ed. Soon is not a time...)

Campaign data submission has officially begun! After much preparation and hard work, the Campaign Team took a deep breath and finally flipped the switch putting the Extranet live on the web for the 2200+ hospitals partcipating in the Campaign. So far so good. Participants have been submitting data at a constant rate, and we haven't yet encountered any serious issues. We're keeping our fingers crossed, but it looks like we're through the woods. Now we are just waiting for everyone to get their data in so we can see what progress has been made over the last six months since we launched -- hopefully lots...If things are going well enough, we might even have another celebration with a cake, and this time we'll put one candle for every life saved...don't worry, we'll keep a fire extinguisher handy just in case the Campaign's progress sets things ablaze at IHI.

Today marks (roughly) the six-month milestone for the Campaign and we’re celebrating with hundreds of Campaign participants at IHI’s hospital summit in San Diego. It’s great to meet and interact with people we’ve been working with so closely since January. We’ve accomplished a great deal to this point – enrolling over 2,200 hospitals in all fifty states, engaging influential and committed national partners – but the work of saving lives has to start in earnest now. Don Berwick made a clear call for teams to get down to work and to make real change in his opening plenary address (available for public consumption soon) and the spirit of his remarks was reflected in the excitement of the evening’s Campaign reception.

A variety of new tools – including a new web site area and new tools for participating teams – were released in conjunction with the event and we’re especially excited by the announcement of our 2005 Summer Tour…the Campaign team aims to visit every node in the country between now and mid-September – we should be pulling into your neighborhood soon…data submission for participating hospitals (starting on June 14^th) is another big event and we’re getting ready for that as we speak.

This summer the Campaign team is going to hit the road and replicate this type of public launch event at every Node on our Summer Tour. We'll keep you posted on the schedule and hope that you'll come on out when we're in your neighborhood.

Today was a great day for the Campaign: our Project Coordinator (and database manager), Jason Reed, confirmed that we have enrolled our two thousandth hospital in the initiative! This means that we have over a third of American hospitals with us in this work and represents a tremendous opportunity for us and for the country. We can’t lose focus on the Campaign’s primary goal of saving lives but for a few minutes we decided that we should enjoy what we’ve accomplished. A delicious cake was served and all of IHI’s staff joined us to celebrate…I had threatened to jump out of the cake but decided that would be a little over-the-top…instead I made Alexi do it.

Today I joined Don Berwick, Jonathan Small, Madge Kaplan and Alexi Nazem for a briefing on the Campaign on Capitol Hill, sponsored by Representatives Patrick Kennedy (D- Rhode Island) and Tim Murphy (R- Pennsylvania), co-chairs of 21st Century Health Care Caucus. Dr. Denise Cardo (CDC), Dr. Bill Rollow (CMS), Laura Miller (VA), and Dr. Carolyn Clancy (AHRQ) also spoke at the briefing as key Campaign partners, each emphasizing how the 100,000 Lives Campaign aligns with and reinforces efforts by the federal government to reduce medical errors and improve health care quality. The purpose of the briefing, scheduled at the invitation of Rep. Kennedy, was to raise awareness about the Campaign among legislators and health care leaders, and to encourage everyone to discuss the initiative with their constituents. It was a great meeting and the response was very positive…other highlights of the trip included taking a behind-the-scenes tour of the White House and carrying thousands of Campaign brochures and buttons through security checkpoints in every congressional building.