Establishing an Ambulatory Medicine Quality and Safety Oversight Structure: Leveraging the Fractal Model

Academic Medicine : Journal of the Association of American Medical Colleges
Steven J KravetPeter J Pronovost

Abstract

Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in ...Continue Reading

References

Jun 17, 2011·The Milbank Quarterly·Mary Dixon-WoodsPeter J Pronovost
Jan 15, 2014·Joint Commission Journal on Quality and Patient Safety·Peter J PronovostUNKNOWN National Leadership Core Measures Work Groups
Sep 23, 2014·Journal of Health Organization and Management·Peter J Pronovost, Jill A Marsteller
Dec 18, 2014·Academic Medicine : Journal of the Association of American Medical Colleges·Peter J PronovostPaul B Rothman
May 21, 2015·Academic Medicine : Journal of the Association of American Medical Colleges·Peter J PronovostUNKNOWN Armstrong Institute for Patient Safety and Quality Team

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Citations

May 19, 2017·Leadership in Health Services·Simon MathewsLisa Ishii
Feb 10, 2018·Journal of General Internal Medicine·Janice L Kwan, Hardeep Singh
Dec 28, 2017·Quality Management in Health Care·Steven J KravetPeter Pronovost
Nov 26, 2019·Journal of Patient Safety·Steven KravetHardeep Singh
Mar 7, 2018·Journal of Health Organization and Management·Peter J PronovostPaul B Rothman
Apr 23, 2019·Journal of Patient Safety·Sonali DesaiAllen Kachalia

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