Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance but has not provided a roadmap for sustained improvement in these assessments. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. After 10 years, the IHQSE has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.

Standardizing the transfer criteria and implementation of a transfer-readiness assessment reduced the time-to-transfer decision out of the PICU from 14.4 hours to 7.8 hours and increased the proportion of patients transferred on >/6Lpm of HHF oxygen in children with viral bronchiolitis. No increase in PICU readmissions or use of rapid response team was found.

A team led by Dr. Justin Honce, Nancy Pritchard, Julia Drose, and Nancy Cheung set out to reduce the inpatient MRI turn-around-time (TAT) from order entry to 1st image acquisition. Pre-intervention TAT was 751 minutes. Through multiple PDSA cycles including redesign of the MRI scheduling and role clarity around which team members would transport the patient and do the MRI screening forms the team was able to reduce the TAT to 401 minutes. Review of the process a year later found most of this gain was sustained.

IHQSE leader Dr. Tyler Anstett and colleagues report on how a systems-based M&M conference with key stakeholders present resulted in significant improvements in completion time of ‘routine’ (18-minute reduction) and ‘now’ (8-minute reduction) ordered inpatient electrocardiograms. This is the first study to show a positive impact on a process following a systems-based case review conference.