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What Happened Next? The Armstrong Institute's quest for 'zero harm' in patient care

Posted September 13, 2017
Peter Pronovost (far right) leads a morning round of nurses, fellows, and residents in the Johns Hopkins Hospital ICU. Suchi Saria (center), an assistant professor of computer science in the Whiting School, observes to understand the unit's workflow before beginning work on systems that can manage its processes. Peter Pronovost (far right) leads a morning round of nurses, fellows, and residents in the Johns Hopkins Hospital ICU. Suchi Saria (center), an assistant professor of computer science in the Whiting School, observes to understand the unit's workflow before beginning work on systems that can manage its processes.

When Rising visited Peter Pronovost in 2013, the C. Michael and S. Anne Armstrong Professor and Director of the Armstrong Institute for Patient Safety and Quality spoke about how the institute would become a critical forum for improving clinical care and safety, where valuable ideas, methods, and data could be developed and shared among experts in and outside of Hopkins, and in and outside of medicine.

"One of the responsibilities of Johns Hopkins Medicine, as one of the world's premier health institutions, is to draw from the university and use our health system as a learning lab, to find out what works, what improves health — and when we find that out, to scale and spread it out across the country and the world," Pronovost said shortly after the Armstrongs made a $10 million commitment to endow the institute and another gift establishing his professorship.

How well has the Armstrong Institute met Pronovost's ambitious goals? He shares an update in this conversation with Rising.

How has the Armstrong Institute had an impact on Johns Hopkins Hospital, specifically?

“We now have a way of tracking quality literally everywhere care is delivered across the health system.”
Peter Pronovost

The Board of Trustees asked us early on, "We know how every dollar is spent or received across Johns Hopkins Medicine — can we say the same thing about quality of care?" We said, "No," because there wasn't any structure to do that. We now have a way of tracking quality literally everywhere care is delivered across the health system. It maps up to an oversight committee on the board that receives standard reports on patient safety and quality just like they do on finances. For example, we monitor five different infection measures in all of our care areas. A dashboard shows us whether we're meeting our goals: If we're better than our goal, it's green; if we're worse, it's red. Until this year, we've never been all green. There was always some red. Now, we're all green.

In this Rising video from 2013, you mention scaling and spreading beneficial measures the institute discovers. What impact has the Institute made outside of Hopkins?

We've just created an Armstrong Institute at Johns Hopkins Bayview to help mature their safety research and improve accountability. We've formed a global collaboration alliance with Ernst and Young to put our programs in place in hospitals around the globe. We have research collaborations in virtually every state in the United States and about 20 different countries. We also worked closely with the World Health Organization to drive their patient-safety efforts. In a short period of time, we've established a brand with our results, and we're looking forward to having our partners share in those results.

What about the institute's influence on domestic U.S. health policy?

Recently, I met with Congressman (Phil) Roe (R-TN), who oversees the House Committee on Veterans Affairs. He read a paper I wrote about governance at Johns Hopkins Medicine. He asked, "Why isn't the VA doing this? Hopkins Medicine is about the same size as the VA — could you come and talk to us?"  What's come of that is next February, he's hosting a roundtable discussion with the Secretary of the VA and Dr. (Paul) Rothman (Frances Watt Baker, MD, and Lenox D. Baker, MD, Dean of the Medical Faculty) to talk about applying our models to the VA. This is thought leadership through academics. We are now working with two visions — the Institute's and the VA's — to implement our quality program.

Why has the institute enjoyed such quick success in delivering on its mission?

We believe we can get to zero harm. Not only do we believe it here, the broader world believes it's possible because of Mike Armstrong's gift. His gift has brought together faculty from every school and division throughout the university to work on this, 20 different disciplines. We pursue what we call transdisciplinary research. Interdisciplinary research means different disciplines working on a common problem, but staying in their own mental models. Transdisciplinary research involves different disciplines working on a common problem through integrated conceptual models, pulling lots of different levers, and that can yield massive improvements — like it did in our infections work. That requires that you know the language of these other disciplines, to understand their theories and approaches. This institute has been a home for this multilingual diversity of science.

To learn more about the Armstrong Institute's work or make a gift, please contact Amy Helsel, senior director of development at the Fund for Johns Hopkins Medicine.