1. Nelson, Roxanne BSN, RN

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What if the goal of health care delivery in the United States were to be perfect? What would that look like? The Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF) have attempted to answer that question by developing a project known as Pursuing Perfection.


"The idea actually came from the Robert Wood Johnson Foundation," says Andrea Kabcenell, MPH, RN executive director of Pursuing Perfection at the IHI. "We know how to improve one problem at a time-how to reduce nursing turnover or cut down on medication errors-but we are looking for organizations that will be able to do it all."


Pursuing Perfection was launched in September 2001, funded by a $21 million grant from the RWJF to cover the first two and a half years of the project; an additional $4 million was later allocated for two more years. The plan was to create models of excellence at selected organizations that would commit to redesigning their systems and initiating improvements in their major care processes.


The IHI and the RWJF chose seven diverse U.S. health care organizations from 226 applicants; six health care providers in Europe joined at their own expense. The organizations selected, says Kabcenell, had already shown a great deal of promise and innovation.


The program's implementation has been largely dictated by the needs and priorities of the individual organizations. One grant recipient, the HealthPartners Medical Group and Clinics in Bloomington, Minnesota, is a large and integrated multispecialty group practice that includes 550 physicians, 40 clinic locations, and two partner hospitals. It focused improvement efforts on providing reliable evidence-based care and improving outcomes in patients with chronic illness, with a special focus on diabetes, depression, congestive heart failure, and care at the end of life.


"Our focus has been on the ambulatory care component rather than the hospital component," says Beth Waterman, vice president, primary care and clinic operations. One new approach has been the use of prepared practice teams, expanded health care teams that include caregivers other than physicians and nurses and were developed to provide more proactive care.


"We broke down the patient visit into several components," says Waterman: before the visit, during the visit, after the visit, and even in-between visits. "There are activities that each member of the team performs at each of those points."

FIGURE. Lynee TateBa... - Click to enlarge in new windowFIGURE. Lynee TateBaker, a certified medical assistant at HealthPartners Riverside Clinic, checks blood pressure at a booth exhibit at the HealthPartners annual meeting in April 2005.

The results are promising, according to Waterman. "We've always had good results for our diabetes measures, compared with other facilities around the country, but this is the first time in our history that we have seen improvements at all of our sites."


The final phase of Pursuing Perfection will end in 2006. Kabcenell says the interim data look good. "Some organizations have more results to report, and some are better than others," she says, "but everyone is willing to share, and we've really made it a learning collaborative. It's the only way to do this project."