From 2005 to 2012, Oakland, Calif.-based Kaiser Permanente Northern California improved multiple quality processes and outcomes across its 21 hospitals by using a "four-wheel drive" framework, according to a study in the Journal for Healthcare Quality.
The four-wheel drive approach includes three major motivations for change:
• Harm. Harm involves reframing quality issues through patient stories, images and other means to emphasize the effect on patients.
• Heart. The heart motivator is emotional engagement in performance improvement.
• Heat. Heat refers to external factors, such as federal regulations, which motivate change.
The four wheels of the model represent necessary forces for improvement:
• Leadership alignment at all levels
• Standardization of care and systematization of processes
• Project management
• Actionable data
Kaiser Permanente Northern California engages facilities in sharing quality improvement experiences and continues to track data to sustain improvements. From 2005 to 2012, the organization has made improvements ranging from 4 percent to 700 percent across various process and outcome measures. For example, it decreased the rate of central line-associated bloodstream infections per 1,000 line days by 68 percent from 2006 to 2012. From 2008 to 2012, the fall rate with major injury per 1,000 patient days decreased 50 percent, as did the rate of Clostridium difficile per 1,000 admissions from 2010 to 2012.
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