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New IHI/NPSF Report: Patient Safety in the Home 0 J. Carmona   Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities   With support from the Gordon and Betty Moore Foundation, IHI/NPSF contracted with Westat to evaluate research on patient safety in the home and identify gaps. This report examines safety issues in the home, including challenges, funding mechanisms to support safe home care, and conceptual frameworks that seek to structure these disparate issues. It concludes with opportunities for research to advance the science of patient safety improvement in the home. Read more and download the report.        
by J. Carmona
Tuesday, September 5, 2017
What to do when improvement plateaus 2 W. Hyman An interesting challenge of bench marking and trending is when the standard is set at some level above zero. This means that someone has decided that some non-zero level of unsafety is OK, and that as long as we stay below that level we are doing well. (There is also the question of OK with who since the injured party has rarely agreed.) But where did that non-zero number come from? And would you really be happy to explain to someone (eg the patient, a lawyer) that yes the patient was injured but their injury was within our acceptable rate of injuries.
by W. Hyman
Wednesday, August 30, 2017
Nurse Sensitive Outcomes Crosswalk/ Dashboard Examples 0 C. Blalock Hello,     Does anyone have a crosswalk comparing different reporting programs for Nurse Sensitive/Driven Outcomes such as Falls, Pressure Injuries, Medication Errors, etc. I was requested to compare NDNQI, CalNOC, PfP, Leapfrog, and AHRQ to determine which program to use for benchmark.   Also, if anyone has an example of a dashboard they use for reporting this information, I'd appreciate see it for ideas. I think we have some opportunity to improve our reporting and make it more meaningful. I was thinking we could have different dashboards by program such as VBP, Nurse Sensitive Outcomes (include nurse staffing ratio & pt experience on it for reference), NHSN, and a separate report for our BHU and IRFs.   Thank you very much.   Casey
by C. Blalock
Monday, August 28, 2017
Projects in Safety: How Teamwork and Research Push Patient Safety Forward 0 J. Carmona     Throughout the month of August we are celebrating ASPPS Member Appreciation Month and are highlighting patient safety projects from ASPPS members. These initiatives remind that real change is possible when teams come together. Take a look at a few of these initiatives in this recent post on 
by J. Carmona
Wednesday, August 23, 2017
ASPPS Member Appreciation Month 0 J. Carmona   There's just one week left to take advantage of the Member Appreciation Month benefits that we are offering through the end of August!   Find out more about membership and the promotions here:   Thank you for your commitment to patient safety. 
by J. Carmona
Wednesday, August 23, 2017
Patient Safety Performance Appraisals 0 M. Burroughs I have to develop some sort of performance appraisal measuring my employees knowledge and implementation of the Patient Safety Curriculum and general staff appraisal regarding patient safety.  Does anyone have any suggestions where to look?  Does anyone have some sort of safety appraisal already in place or some safety measurements incorporated into an existing appraisal form?  Asking before I create the wheel.  Thank you in advance
by M. Burroughs
Monday, August 21, 2017
MITSS HOPE Award: Nominations now being accepted 0 P. McTiernan The HOPE Award is presented annually to anyone who exemplifies the mission of MITSS (Medically Induced Trauma Support Services) -- Supporting Healing and Restoring Hope to patients, families, and clinicians impacted by adverse medical events. Learn more and nominate someone today,  
by P. McTiernan
Monday, August 21, 2017
Want to Advance Patient Safety and Your Professional Goals? 0 P. McTiernan Prepare for Certification in Patient Safety The Certified Professional in Patient Safety credential (CPPS) distinguishes health care professionals who meet competency requirements in patient safety science and who demonstrate the ability to apply this knowledge to effectively plan and implement patient safety initiatives.   Get help preparing for the exam Certified Professional in Patient Safety (CPPS) Review Course Webinar Thursday, September 14, 2017 10:00 am – 4:30 pm Eastern Time Register now or learn more. The course can help participants prepare for the exam by reviewing domain content areas and test-taking strategies. It provides participants with the opportunity to: Review the patient safety domain content areas, following the exam content outline Evaluate patient safety scenario examples similar to actual exam questions Assess their own level of preparedness for the exam and address additional areas for self-study Already certified? This program is approved for six (6) contact hours toward the fulfillment of the requirements of CPPS recertification.
by P. McTiernan
Thursday, August 17, 2017
Submit Your Improvement Story 0 P. McTiernan We invite you to submit your improvement work for display as a storyboard at the 2017 IHI National Forum. The submission process is now open, and the deadline for submitting a general storyboard for display at the National Forum is September 29, 2017, 11:59 PM ET. Learn more at
by P. McTiernan
Wednesday, August 9, 2017
8/8 Webcast: Patient Flow and Patient Safety 0 K. Rowbotham Thank you to those who attended the August 8, 2017 Professional Learning Series webcast titled Patient Flow and Patient Safety with Pat Rutherford, RN, MS of the Institute for Healthcare Improvement, Marti Taylor, MSN of The Ohio State University Wexner Medical Center, and Frederick Ryckman, MD of Cincinnati Children's Hospital Medical Center.   Additional resources: Download a 2003 IHI white paper on the topic of patient flow. Listen to a WIHI Replay. Register for the live Hospital Flow Professional Development Program held on October 30-November 2 in Boston, MA.   We encourage you to continue the discussion by adding your comments or questions below.
by K. Rowbotham
Tuesday, August 8, 2017
Request for Proposals: Reducing Diagnostic Error 0 P. McTiernan Interested in addressing diagnostic error in your organization? Please consider applying to become a member of the first SIDM-IHI collaborative to develop and prototype interventions in your own practice setting. The Society to Improve Diagnosis in Medicine (SIDM) and the Institute for Healthcare Improvement (IHI), with funding from the Gordon and Betty Moore Foundation, are jointly sponsoring a prototyping collaborative project that will engage six selected health care organizations to trial one or more interventions aimed at improving the diagnostic process and its outcomes. The National Academy of Medicine’s landmark report, Improving Diagnosis in Health Care, identified diagnostic error as a major, unaddressed patient safety issue, noting that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.”   The SIDM-IHI initiative will directly address one of the major goals from the report, to “Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.” The selected health care organizations will each be asked to join a six-month collaborative during which they will learn improvement skills and test one or more interventions to reduce diagnostic error. Using the unique “IHI Collaborative” approach that has successfully advanced safety and quality work over the past decade, the participating organizations will work and learn together in this effort, sharing problems, insights, and lessons learned.   Full details can be found in the RFP: Download the RFP at   The deadline for applications is Sept 8, 2017,and the deadline for questions is August 11, 2017. Address questions to
by P. McTiernan
Thursday, August 3, 2017
Patient Flow & Patient Safety: Webcast August 8 0 P. McTiernan Patient Flow & Patient Safety Professional Learning Series Webcast Tuesday, August 8, 2017 | 1:00 PM Eastern Time Register or learn more at Optimizing patient flow throughout the hospital is essential to ensuring safe, high-quality, patient-centered, value-based care. Providing timely access to appropriate care and optimizing hospital flow are both critical levers to increasing value for patients, clinicians, and health care systems.   Conversely, poorly managed hospital-wide patient flow has critical implications for both patients and providers. Delays in treatment and failing to provide the right care, in the right place, at the right time puts patients at risk for potential harm and suboptimal care. It also increases the burden on clinicians and accelerates burnout. In this webcast we will explore high-leverage strategies and interventions to improve hospital-wide patient flow -- making sense of the variety of hospital-wide strategies and approaches needed to deliver the right care, in the right place, at the right time.
by P. McTiernan
Thursday, July 27, 2017
Complimentary Session on Communication and Resolution Programs 0 P. McTiernan Communication and Resolution Programs: Achieving the Benefits, Avoiding the Pitfalls Complimentary Program Tuesday, August 29, 2017 | 8:30 AM – 4:30 PM The Fairmount | Chicago, IL Presented by the Collaborative for Accountability and Improvement and IHI/NPSF   Communication and Resolution Programs (CRPs) are rapidly becoming the best practice across health care for preventing and responding to adverse events. An effective CRP can improve health care quality and safety, patient trust and satisfaction, and lower liability costs. Yet important barriers can reduce the likelihood of a CRP’s success. Learn more about this complimentary session.   To register, contact Caroline Bell at or 650-206-3052.
by P. McTiernan
Wednesday, July 26, 2017
Patient Advocate Scholarships to IHI National Forum 0 P. McTiernan The Institute for Healthcare Improvement (IHI) recognizes the importance of working in partnership with patients and family members to improve the quality and safety of health care.   This year, IHI is proud to provide funding to support the registration, up to $500 toward travel, and three nights’ lodging for a limited number of exceptional Patient/Family Advisors who are contributing to the field of person-and family-centered care. A Patient/Family Advisor is a person with lived experience as a patient or family member who is collaborating with a health care organization and shows success, drive, and interest in improving the patient experience.   To learn more and apply for this opportunity or download the application, visit this page and scroll to the bottom.
by P. McTiernan
Wednesday, July 19, 2017
AHRQ Antibiotic Stewardship Project 0 P. McTiernan AHRQ is seeking hospitals to join a national project that aims to reduce harms related to inappropriate use of antibiotics while preserving antibiotics’ effectiveness for future generations. Learn how participation can benefit your patients and hospital. The 12-month project, which is offered at no charge to hospitals, will begin in December 2017.   Upcoming Webinars for Hospitals Interested in AHRQ Antibiotic Stewardship Project
by P. McTiernan
Tuesday, July 18, 2017
Making the Business Case for Patient Safety 0 P. McTiernan This new resource toolkit from the IHI/NPSF Patient Safety Coalition, Optimizing a Business Case for Safe Health Care: An Integrated Approach to Safety and Finance, offers guidelines and tools to use in assessing organizational readiness for a safety initiative, gathering information and data, drafting a business case for the work, and delivering a compelling presentation to decision makers.   Read more and download the guide and tools.   Read a blog post by Tejal Gandhi, MD, MPH, CPPS, 3 Keys to a Compelling Business Case for Patient Safety Work,
by P. McTiernan
Thursday, July 13, 2017
Patient Safety Department 0 T. Parker Greetings!   I am new in my role as Patient Safety Officer at Hendrick Medical Center in Abilene, TX.  The Hendrick name reigns over a 522-bed medical center, a women’s center, rehabilitation hospital, cancer center and numerous other innovative services. Within your patient safety department, how many staff members and what roles do your employees play? 
by T. Parker
Wednesday, July 5, 2017
exam application 4 S. Calzada Gil Quote: Originally posted by G. yehia saad: How I will apply for the exam   Thank you for your inquiry. For information on how to apply to take the CPPS examination, please see
by A. Spielman
Thursday, June 29, 2017
2017 IHI National Forum 0 P. McTiernan Where can you find 200 workshops, 9 keynotes and featured speakers, 10 new topic tracks, and 5,000 of your brilliant peers? At the 2017 IHI National Forum this December 10-13 in Orlando. Learn more and register now: Have you been to the Forum in past years? Tell us what the best part is. Will you be coming for the first time? What are you most looking forward to?
by P. McTiernan
Thursday, June 29, 2017
Optimizing a Business Case for Safe Health Care 1 P. McTiernan A bigger challenge might be safety that isn't "cost effective", an issue which includes how you calculate cost, and cost to whom? This challenge includes the often used but not viable "if we could save just one life" argument. But it also creates the trap of trying to explain safety not achieved as being too expensive. This invites a scrawled $ with the faux outrage of "you mean Mr X died because of this???"   Some might remember the late and unlamented exploding car that attracted so much of Ralph Nader's attention for which the manufacturer had documented that the cost of solving the problem exceeded the probable payouts to those that were killed by it. This position proved to be unattractive once revealed.   An analogy I have used before, and maybe here, is that I live in a large apartment building that includes many older people (including me). Lives might be saved if there was an ambulance parked in front of the building at all times. But this isn't practical, so we collectively settle for some arbitrary response time, risking life to limit cost.
by W. Hyman
Tuesday, June 27, 2017
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Webcast: Fresh Facts: Hospital Falls and Fall Prevention

9/10/2018 » 9/12/2018
IHI/BMJ International Forum on Quality & Safety in Healthcare

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