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The Campaign to Save 100,000 Lives

Table A. All information in this table was taken from the materials provided to participants at the IHI Annual Forum, Orlando, FL, December 14, 2004.

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All information in this table was taken from the materials provided to participants at the IHI Annual Forum, Orlando, FL, December 14, 2004.

Table B. All information in this table was taken from the materials provided to participants at the IHI Annual Forum, Orlando, FL, December 14, 2004.

click for large version

All information in this table was taken from the materials provided to participants at the IHI Annual Forum, Orlando, FL, December 14, 2004.

I have placed in Table 1, the information (goals, background, proposed interventions and success stories) handed out during Dr. Donald Berwick’s opening plenary session, the kick-off for the campaign to save 100,000 lives.

Two key components of the descriptions above deserve further explanation. One of the key components is the concept of reliability. Reliability is how often something in health care does what it is supposed to do, in the time frame it is supposed to do it in. The formula is the number of times that something (delivery of a medication or service) is done correctly divided by the number of times that same something is attempted. In work published by Karl Weick, one common principle within high reliability organizations is that of a preoccupation with failure. As such, the notation of reliability is a measure of defects. Currently much of healthcare (including use of beta-blockers after AMI) functions at a 10-1 level of performance (one defect in 10 tries) or less than a 90% success rate. Organizations that have actively embraced this concept of reliability in their quality improvement work have rejected the usual satisfaction with 10-1 performance. Shouldn’t 99 out of 100 (or 999 out of a 1,000) patients with an AMI get what they are supposed to get?

The other key component embedded within some of the six items that save lives is the concept of bundles. Rather than considering individual measures for each of the items within a bundle, a composite or aggregate measure is reported. Bottom line is that doing any one or two of the items in a bundle is not good enough. It will not achieve the same reduction in hospital acquired infection rates or mortality, as doing all of the items in concert for every appropriate patient.

How can hospitalists help achieve this national goal, to participate in this campaign with the IHI? As individuals, we can be a hospital “precinct captain” or champion, speak to our hospital boards, convene colleagues to standardize to science, start medication reconciliation, and seek composite reliability in our own individual practices.

The IHI will measure this campaign in four ways.

Level 1. Number of hospitals “signing up”

Level 2. Changes in process of care reported

Level 3. Actual changes in deaths and death rates (sample amongst volunteer hospitals)

Level 4. Hospital Standardized Mortality Rates (work of Brian Jarman)

More detailed and specific information about the campaign (and how to participate) can be found on IHI’s Web site (www.ihi.org/ihi/programs/campaign).

“Some is not a number. Soon is not a time.”

The number: 100,000 lives.

The time: June 14, 2006 – 9 a.m. EDT.

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