Pronovost is well-known for a program he led that significantly reduced rates of central line-associated bloodstream infections. But even that work focused on only one type of harm, and the protocols it requires are an added burden for busy clinicians, he said.
The foundation kicked off the initiative with an $8.9 million grant to Johns Hopkins' Armstrong Institute to improve ICU care.
Pronovost, who will lead the effort, said the money will be used to create a “a mini-Bell Labs” that will draw expertise from the university's schools of medicine, nursing, engineering, public health, business and applied physics to re-imagine care.
The goal is to create an ICU where monitoring devices, infusion pumps and other machines can “talk” to each other and make adjustments as needed, treatment plans—sometimes consisting of as many as 200 steps—are standardized and automated, and information technology systems alert clinicians to risks of harm.
As part of that effort, researchers will design open-source middleware that will link ICU devices. Pronovost said he envisions an ICU in which patients' families make rounds with physicians, assess treatment plans and provide feedback.
Patient-safety experts lauded the program for its systems approach and for its emphasis on patient and family empowerment. Diane Pinakiewicz, president of the Boston-based National Patient Safety Foundation, praised the foundation's reputation for funding forward-thinking and scalable projects. “Their dedication to patient dignity is so refreshing,” she said. “Patients and their families have not been welcomed to the conversation in the past and that has been a missed opportunity.”
She also said the program's target of “zero harm” is the right one. “That's exactly the end point we need to have in our minds at all times,” she said.
It's not the first time the foundation has addressed healthcare safety. Created in 2000 by Intel Corp. co-founder Gordon Moore and his wife, the organization, whose assets total more than $5.5 billion, focuses on science, environmental conservation and patient care. In 2003, the foundation established the Betty Irene Moore Nursing Initiative, which has awarded more than $100 million in grants to improve nursing care in communities surrounding San Francisco and Sacramento, Calif.
But the Patient Care Program will run indefinitely and as a national program will be much larger in scope, McCormick said. The program also enlists the help of a number of strategic partners, including Consumers Union, Stanford University and UnitedHealth Group.
Researchers at the University of California at San Francisco also secured a $2.1 million grant from the foundation to study workflow patterns, interpersonal communication and other aspects of care in ICUs. Led by Dr. Scott Reeves, director of UCSF's Center for Innovation in Interprofessional Healthcare Education, the team will spend two years observing four hospital ICUs in each year. “We want to get a deep understanding of what really goes on in the ICU, what works well and what doesn't,” he said.
The Institute of Medicine and the National Academy of Engineering also are partnering with the foundation on the initiative, said Dr. J. Michael McGinnis, a senior scholar at the IOM. Their contributions will include providing a forum where professionals in medicine and engineering can learn more about their fields and find ways to collaborate, he said.
Dr. Donald Berwick, senior fellow at the Center for American Progress and former CMS administrator, said the Patient Care Program marks a maturation in the healthcare industry's approach to improvement. Berwick co-founded the Cambridge, Mass.-based Institute for Healthcare Improvement, whose systems-based approaches provided much of the foundation for the Patient Care Program.
“For the first couple of decades, the work in patient safety and process improvement focused on individual diseases and risks,” Berwick said. “That was an important time when we were cutting our teeth. What is happening now, though, is an understanding that excellence is a systemic property and that means being able to remake systems in their entirety. That's the next step for the quality movement.”