US firm to advise Scottish health service on quality improvement

BMJ 2007; 335 doi: (Published 23 August 2007) Cite this as: BMJ 2007;335:366
  1. Bryan Christie
  1. Edinburgh

    One of the world's leading health improvement organisations, the US based Institute for Healthcare Improvement, is to work with the NHS in Scotland to improve patient safety. It is said to be the first time that an entire national healthcare system has become involved in an initiative of this kind.

    NHS Quality Improvement Scotland has commissioned the institute to help coordinate the Scottish Patient Safety Alliance. This will involve staff at all levels taking simple steps to tackle problems such as preventable infections or errors in prescribing.

    The institute is a not for profit organisation that led the successful “100 000 lives campaign,” which made important improvements to US hospitals.

    Participating hospitals avoided at least an estimated 122 000 unnecessary deaths during the 18 month campaign. The institute has since launched the “five million lives campaign” to extend the success of this initiative.

    The institute is already improving patient safety in the United Kingdom as part of the UK Health Foundation's “safer patient initiative.” In the first phase the institute's specialists made improvements at four NHS trusts—Luton and Dunstable NHS Trust, in England; Conwy and Denbighshire NHS Trust, in Wales; Down Lisburn Health and Social Services Trust, in Northern Ireland; and NHS Tayside, in Scotland. In the first two years of the programme the number of recorded adverse events fell by half. The initiative has been extended to include 20 more trusts.

    The programme is based on identifying good practice and ensuring that it is reliably and consistently applied to key areas. Measures include setting up processes to ensure that all patients receive the right drugs at the right time and at the right dose; implementing monitoring systems to identify patients whose conditions are deteriorating more quickly; and looking at ways to improve hand washing.

    David Steel, the chief executive of NHS Quality Improvement Scotland, said that Scotland will seek to build on the success that has already been achieved in the “100 000 lives campaign” and the “safer patient initiative.” “Our approach will be to work with staff to make the changes in their own workplace that will improve safety. These changes may be small on their own, but taken together they can add up to a huge change for the NHS as a whole.”

    Research from around the world has estimated that about one in 10 patients experiences unnecessary harm or suffering caused by adverse events. Don Berwick, president and chief executive officer of the institute, has said, “No one in health care can feel comfortable with the magnitude of infection, adverse drug events, and other complications that hospital patients endure. We can and we will equip all willing healthcare providers with the tools they need to make the motto ‘first, do no harm' a reality.”

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