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Editorial Overview
Quality through Sustainability and Transferability
The Vohs Award for Quality and The Lawrence Award for Patient Safety
By Tom Janisse, MD
Is an innovative practice that improves quality sustainable? Can it be transferred to other sites in a whole system of care for a large population? The future of American medicine depends on affirmative answers. This issue’s four Original Articles answer these more difficult questions about quality innovation through successful demonstrations. A good idea is not enough, and as noted by Arthur Huberman, MD, who chaired the Transfer of Successful Practices Workgroup of the Kaiser Permanente (KP) Care Experience Council: "The complexity involved in transferring successful practices is often underestimated. It involves much more than knowledge of the technical aspects involved. In fact, cultural issues usually present the most significant challenges."1
The organizational process that lifts the most successful of these practices into view and recognizes them includes the Vohs Award for Quality and the Lawrence Patient Safety Award. With this issue, The Permanente Journal has published 23 Vohs Award projects over a seven-year period, and five Lawrence Award projects over three years, representing many KP regions and most major medical specialties.
The Vohs Award
The James A Vohs Award for Quality is presented for the project(s) judged to best represent an effort to improve quality through documented, institutionalized changes in direct patient care. The innovation from the Colorado Region--"Chronic Care Coordination Program: Home-based Medication Reconciliation Following Discharge from a Skilled Nursing Facility"--is the recipient of the 2007 Vohs Award. Because of its relevance to the Original Articles in our upcoming Fall issue, we will publish this project then. In this Summer issue we publish the second-place selection, Northern California Region’s innovation--"Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women"--which was successfully transferred first to multiple prenatal units, then to multiple medical centers and now multiple KP regions and even multiple non-KP county clinics.
The Lawrence Award
The David M Lawrence, MD, Chairman’s Patient Safety Award recognizes projects that advance the quality of care by improving the safety of care. The preferential project demonstrates a change in outcomes, involves members from various disciplines, and exhibits capability of replication interregionally. The innovation from the Northern California Region--"Promoting Patient Safety: The Rapid Medical Response Team"--received the 2006 David M Lawrence, MD, Patient Safety Award. The practice--a team of critical care experts to prevent, in nonICU patients, deterioration leading to resuscitation--has now been implemented in all 18 KP medical centers in Northern California.
Sustainability and Transferability
The two additional studies in the Original Articles section also demonstrate transferability. "Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care," examines the practices of four different primary care teams in three regions; and "Church-Based Heart Health Project: Health Status of Urban African Americans" evaluates the effectiveness of transferring cardiovascular risk screening from clinic to the site of a community gathering of largely non-KP members.
Transferability of innovative practices is a necessary outcome for both local systems and national systems if we are to improve American medicine as a whole. Whereas each of the four studies in the Original Articles section present new data and discussion, the particular relevance for American medicine of publishing this set is as a studied perspective on sustainability and transferability of health care innovations.
Reference
1. Huberman A. The idea: innovation and transfer. Perm J 2005 Fall;9(4):36.
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