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The Hospital Leaders Toolbox provides leaders – from the boardroom to the front line – with concepts, tools, and resources to win the war on healthcare harm.
The Toolbox, on DVD, will be sent for FREE to all U.S. hospitals including the full version of the Chasing Zero documentary. Extra copies may be ordered here.
See our featured video, Ground Zero: The Boardroom, Not the Bedside, in the player below.
Click here for terms and conditions of use for Chasing Zero: Winning the War on Healthcare Harm documentary and the Hospital Leaders Toolbox
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HHS: 1 In 7 Experiences Adverse Event During Hospital Stay
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The Department of Health and Human Services, Office of the Inspector General, released an important report related to patient safety on November 16, 2010, entitled Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries – featured in an article on USAToday.com. To download the report, click here.
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Leaders Toolbox
Checklists: Concepts, Tools, and Available Resources
Click on the Safe Practice title or the expand button below to list the Concepts, Tools, and Resources available for you.
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SP 1: Culture of Safety Leadership Structures and Systems
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| CONCEPTS |
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Are you infected? (2009)
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J Patient Saf
2009 Sep;5(3):188-96.
Download the PDF.
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The title of this article may lead you to believe that it is about healthcareYassociated infections
(HAIs), but the theme concentrates on leadership. As it turns out, the article is about both. The
power of the human spirit, our values, and the force magnifier of social networks are untapped
resources we can le...
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CEOs: Meet Your New Revenue Preservation Officer...Your PSO!
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J Patient Saf
2008 Sep; 4(): 201-11.
Download the PDF.
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Value-based purchasing (VBP) is a good news-bad news proposition for hospital leaders
and patient safety leaders. The good news for Chief Executive Officers (CEOs) is that
they will appreciate the value of patient safety in the financial language they understand.
The bad news, for those who have not adequately...
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Hospital Governance And The Quality Of Care (2009)
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Health Aff
2010;29(1):published online 6 November 2009;10.1377/hlthaff.2009.0297.
Download the PDF.
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Hospitals’ boards may influence the quality of care that hospitals provide, but
their engagement in quality-related issues is largely unknown. We surveyed a nationally representative
sample of board chairs of 1,000 U.S. hospitals to understand their expertise,
perspectives, and activities in clinical quality. W...
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Leaders Need Dashboards, Dashboards Need Leaders (2006)
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J Patient Saf
2006 Mar, 2(1):45-53.
Download the PDF.
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Performance dashboards are rapidly evolving hospital leadership decision support tools.
In health care, they are not generally designed with direct input by governance boards,
administrative, or medical leaders. Few incorporate the stated values or mission of the
organization. They have typically been formulate...
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No Excuses: The Reality That Demands Action (2005)
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J Patient Saf
2005 Sep;1(3):154-69.
Download the PDF.
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At least six excuses sabotage dramatic improvement in
hospital safety. Sometimes they are voiced, but more often they are
the elephants in the room, representing barriers to action that no one
wants to recognize. They are ever present in hospitals across the
country and the excuses they embody include: (1) the...
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The 3 Ts of leadership engagement: truth, trust and teamwork (2006)
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AJ Patient Saf
2006 Sep;2(3):162-70.
Download the PDF.
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The single most important ingredient for transformational high performance improvement is
leadership; yet we have a leadership vacuum at the frontline. The 3 T’s of truth, trust, and teamwork offer a
conceptual framework of actions that can be taken to engage trustees, senior administrative leaders,
independent...
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The Patient Safety Battles: Put on Your Armor (2006)
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J Patient Saf
2006 Jun;2(2):97-101.
Download the PDF.
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The patient safety arena offers great reward yet great personal and professional risk for its stakeholders.
In the final analysis, the patient safety battles include both the conflicts of interests between people
and the eternal battle against organizational inertiaVa faceless enemy that never sleeps. Patient sa...
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| TOOLS |
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IHI Improvement Map: Governance & Improvement (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Patients & Families (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Portfolio of Projects (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Reliable Processes (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Scanning (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Set Direction: Aims (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI: Protecting 5 Million Lives from Harm (2009)
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View the document.
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Do No Harm. It is a fundamental principle for health care providers: primum non nocere – first, do no harm. It is our duty, our responsibility. Patients ask and assume that the health care that intends to help them should, at the very least, not injure them.
Despite the extraord...
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| RESOURCES |
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CMS: Physician-Hospital Collaboration Demonstration (2009)
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View the document.
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The MHCQ demonstration projects are intended to “...examine health delivery factors that encourage the delivery of improved quality in patient care, including—1) the provision of incentives to improve the safety of care provided to beneficiaries; (2) the appropriate use of best practice guidelines by providers and...
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IHI: Leadership committed to safety (2009)
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View the document.
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Leadership is a critical function in promoting high quality, safe health care. In health care organizations, leadership is provided by the governing body, the chief executive and senior managers, and the leaders of the clinical staff. When a sentinel event occurs in a health care organization, inadequate or ineffe...
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SP 3: Teamwork Training and Skill Building
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| CONCEPTS |
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There are no concepts available at this time.
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| TOOLS |
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IHI Improvement Map: Communication & Teamwork (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI: Establish a Rapid Response Team (2009)
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View the website.
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The Rapid Response Team — known by some as the Medical Emergency Team — is a team of clinicians who bring critical care expertise to the bedside. Simply put, the purpose of the Rapid Response Team is to bring critical care expertise to the patient bedside (or wherever it’s needed).
...
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IHI: SBAR Toolkit (2009)
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View the website.
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SBAR (Situation, Background, Assessment, Recommendation) is an effective and efficient way to communicate important information. SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured.
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LFG: The Leapfrog Hospital Survey (2009)
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View the website.
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A 1999 report by the Institute of Medicine (IOM) found that up to 98,000 Americans die every year from preventable medical errors made in hospitals. The report recommended that large healthcare purchasers
provide more market reinforcement for quality and safety. The Leapfrog Group (Leapfrog), a growing consortium...
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| RESOURCES |
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AHRQ: Medical Teamwork and Patient Safety (2009)
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View the website.
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A 1999 report by the Institute of Medicine (IOM) suggests that medical errors are responsible for as many as 98,000 deaths annually. In response to this crisis, then President Clinton established the Quality Interagency Coordination (QuIC) Task Force to develop a Federal plan for reducing the number and severity o...
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AHRQ: Rapid Response Systems (2009)
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View the website.
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Rapid response teams represent an intuitively simple concept: When a patient demonstrates signs of imminent clinical deterioration, a team of providers is summoned to the bedside to immediately assess and treat the patient with the goal of preventing intensive care unit transfer, cardiac arrest, or death. Such tea...
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AHRQ: Teamwork Training (2009)
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View the website.
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Providing safe health care depends on highly trained individuals with disparate roles and responsibilities acting together in the best interests of the patient. Communication barriers across hierarchies, failure to acknowledge human fallibility, and lack of situational awareness combine to cause poor teamwork, whi...
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SP 4: Risks and Hazards
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| CONCEPTS |
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Are You Listening...Are You Really Listening? (2008)
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J Patient Saf
2008;4(3):148-61
Download the PDF.
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Objectives: This is the first of a series of articles addressing the
concepts, tools, and resources that can be applied to an enormous
performance gap in verbal communication among patients, families,
frontline caregivers, physicians, and health care-organization administrative
and governance...
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Global Trigger Tool: Implementation Basics (2008)
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J Patient Saf
2008 Dec;4(4):245-9.
Download the PDF.
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The use of "triggers", or clues, to identify adverse events
(AEs) during manual chart review has been found to be a useful
method for measuring the overall level of harm in a health care
organization. The Institute of Healthcare Improvement Global Trigger
Tool for Measuring Adverse Events provides a practical...
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| TOOLS |
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AHRQ: Root Cause Analysis (2009)
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View the document.
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Root cause analysis (RCA) is a structured method used to analyze serious adverse events. Initially developed to analyze industrial accidents, RCA is now widely deployed as an error analysis tool in health care. A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while a...
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AHRQ: Voluntary Patient Safety Event Reporting (2009)
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View the document.
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Patient safety event reporting systems are ubiquitous in hospitals and are a mainstay of efforts to detect patient safety events and quality problems. Incident reporting is frequently used as a general term for all voluntary patient safety event reporting systems, which rely on those involved in events to provide...
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IHI: Global Trigger Tool for Measuring Adverse Events (2009)
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View the webpage.
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Traditional efforts to detect adverse events have focused on voluntary reporting and tracking of errors. However, public health researchers have established that only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to ident...
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IHI: How to improve medication systems (2009)
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View the webpage.
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Improving medication systems should result in a reduction in harm to patients. Achieving breakthrough levels of improvement in reducing harm from medications requires that an organization make changes to improve four fundamental areas in parallel
...
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| RESOURCES |
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AHRQ: National Healthcare Disparities Report (2008)
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View the document.
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Examining health care disparities is an integral part of improving health care quality. Health care disparities are the differences or gaps in care experienced by one population compared with another population. As the National Healthcare Quality Report (NHQR) shows,Americans too often do not receive care that the...
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AHRQ: National Healthcare Quality Report (2008)
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View the document.
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Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or...
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AHRQ: Promoting a Culture of Safety (2009)
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View the document.
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In a number of high hazard organizations, where the risk of error involves dire consequences, leaders manage for safe, reliable performance. As a result, the term High Reliability Organization has been coined to describe organizations with exemplary track records of safety: aviation, chemical manufacturing, shippi...
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CMS: Centers for Medicare & Medicaid Press Release (2008)
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View the document.
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The Centers for Medicare & Medicaid Services (CMS) today proposed additional steps to strengthen the tie between the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital.
CMS is proposing to expand the list of conditions which are reasonabl...
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CMS: Hospital-Acquired Conditions Overview (2009)
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View the document.
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On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section 5001(c) of DRA requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, an...
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SP 21: Central Line-Associated Bloodstream Infection Prevention
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| CONCEPTS |
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| TOOLS |
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IHI Improvement Map: Central Line Bundle (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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| RESOURCES |
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AHRQ: National Healthcare Disparities Report (2008)
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View the document.
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Examining health care disparities is an integral part of improving health care quality. Health care disparities
are the differences or gaps in care experienced by one population compared with another population. As the
National Healthcare Quality Report (NHQR) shows,Americans too often do not receive care that t...
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AHRQ: National Healthcare Quality Report (2008)
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View the document.
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Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or...
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IHI: Implement the Central Line Bundle (2009)
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View the website.
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Central venous catheters (CVCs) are being increasingly used in the inpatient and outpatient settings to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream (bacteremia) and hemodynamic changes and o...
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Prevention of intravascular catheter-associated infections
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Saint S
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AHRQ evidence report, number 43, July 20, 2001. Ch 16. View the document.
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Summary
Central venous catheters inserted for short-term use have become common and important devices in caring for hospitalized patients, especially the critically ill. While they haveimportant advantages (e.g., ability to administer large volumes of fluid), short-term vascular catheters are...
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Prevention of intravascular catheter-related infections
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Mermel LA
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Ann Intern Med. 2000;132(5):391-402. View the document.
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Purpose
To review the literature on prevention of intravascular catheter-related infections.
Data Sources
The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Primary authors were contac...
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SP 22: Surgical-Site Infection Prevention
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| CONCEPTS |
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There are no concepts available at this time.
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| TOOLS |
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IHI Improvement Map: Antibiotic Stewardship (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Surgical Checklist (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI: Surgical Site Infections (2009)
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View the website.
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Many organizations have developed tools in the course of their improvement efforts — successful protocols, order sets and forms, instructions and guidelines for implementing key changes — and are making them available on IHI.org for others to use or adapt in their own organizations.
We have posted too...
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| RESOURCES |
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AHRQ: National Healthcare Disparities Report (2008)
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View the document.
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Examining health care disparities is an integral part of improving health care quality. Health care disparities
are the differences or gaps in care experienced by one population compared with another population. As the
National Healthcare Quality Report (NHQR) shows,Americans too often do not receive care that t...
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AHRQ: National Healthcare Quality Report (2008)
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View the document.
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Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or...
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AHRQ: Prevention of Surgical Site Infections (2009)
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View the document.
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Surgical site infections (SSI) include superficial incisional infections, infections of the
deep incision space and organ space infections.1,2 A large body of evidence supports the premise
that SSIs can be prevented through administration of appropriate prophylactic antibiotics. Two
national organizations, the...
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An Introduction to Surgical Site Infections (2005)
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View the website.
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Before the mid-19th century, surgical patients commonly developed postoperative “irritative fever,” followed by purulent drainage from their incisions, overwhelming sepsis, and often death. It was not until the late 1860s, after Joseph Lister introduced the principles of antisepsis, that postoperative infectious m...
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Hospital infection issue sparks unusual patient protest in Kentucky
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No Authors Listed
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Modern Healthcare. 2007 Aug 7. Download the PDF.
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Ask hospital executives what keeps them up at night, and it's highly unlikely they could conjure up a "Twilight Zone'' scenario as
disturbing as this one: While local television cameras capture the scene for the 6 p.m. news, dozens of former patients stage a
loud, angry protest on the sidewalk outside the hospit...
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Strategies to Prevent Surgical Site Infections in Acute Care Hospitals (2008)
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Polk Jr HC
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Infect Control Hosp Epidemiol.
2008 Oct;29 Suppl 1:S51-61.
Download the PDF.
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Previously published guidelines are available that provide
comprehensive recommendations for detecting and preventing
healthcare-associated infections. The intent of this document
is to highlight practical recommendations in a concise
format designed to assist acute care hospitals to implement
and prioritize...
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SP 23: Daily Care of the Ventilated Patient
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| CONCEPTS |
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There are no concepts available at this time.
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| TOOLS |
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IHI Improvement Map: Ventilator Bundle (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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| RESOURCES |
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AHRQ: Prevention of Ventilator-Associated Pneumonia (2009)
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View the website.
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Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in the intensive care unit (ICU). The incidence of VAP varies greatly, ranging from 6 to 52% of intubated patients depending on patient risk factors. The cumulative incidence is approximately 1-3% per day of intubation. Overall, VA...
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An Overview of Ventilator-Associated Pneumonia (2005)
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View the website.
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Pneumonia has accounted for approximately 15% of all hospital-associated infections and 27% and 24% of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. It has been the second most common hospital-associated infection after that of the urinary tract. The primary...
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SP 24: Multidrug-Resistant Organism Prevention
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| CONCEPTS |
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There are no concepts available at this time.
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| TOOLS |
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IHI Improvement Map: Antibiotic Stewardship (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Infection Prevention (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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IHI Improvement Map: Standard Precaustions (2009)
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View the improvement map.
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The IHI Improvement Map is an interactive online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care. Processes can be browsed or directly searched. Each process contains an overview of the issue detailing critical elements and measures, reasons a...
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TJC: Complimentary MDRO Toolkit (2009)
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View the website.
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Multidrug-resistant organisms (MDROs) prevention and control is one of the most complex management issues that health care executives face. The clinical and financial burden to patients and health care providers is staggering. According to Barbara Soule, JCR Practice Leader, Infection Prevention and Control Servic...
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| RESOURCES |
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AHRQ: National Healthcare Quality Report 2008
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View the document.
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Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or...
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SP 26: Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention
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| CONCEPTS |
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There are no concepts available at this time.
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| TOOLS |
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AORN Correct Site Surgery Toolkit
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Download the ZIP file.
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2009 Correct Site Surgery Tool Kit; Facts on Universal Protocol from the Joint Commission June 2008; CSSTK Pocket Guide; Updated Sentinel Event Statistics from the Joint Commission; Additional Correct Site Surgery Resources (2009)...
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IHI: Pausing for Safety (2006)
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View the website.
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Imagine you’re about to undergo a minor medical procedure. You’ve already read and signed an informed consent form that describes unfortunate things that could happen in the course of the procedure. Now a member of the medical team pauses, and announces your name and the nature of what’s going to happen next to ev...
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IHI: Procedural Pause Audit Tool (2009)
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View the website.
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Virginia Mason Medical Center (VMMC) implemented a Procedural Pause protocol to prevent wrong site, wrong procedure, and wrong person surgery. To gauge compliance with the new protocol, the medical center conducts monthly audits of departments every time they perform ten procedures or more....
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| RESOURCES |
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Chasing Zero® is a registered trademark of CareFusion Corporation.
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