Cerese J, Chang P, Graves K
… +8 more, Grubeling N, Ikezuagu M, Levine D, Lu A, Miller M, Schaal S, Sauls T, Siddiqui M
Am J Med Qual
· 2025 Nov-Dec 01 · PMID 40956281
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Health system executives continually aim to understand how organizational structures impact performance, especially in quality departments. This article, built on over 2 decades of Vizient research, identifies key charac...Health system executives continually aim to understand how organizational structures impact performance, especially in quality departments. This article, built on over 2 decades of Vizient research, identifies key characteristics of top-performing healthcare organizations. The researchers employed a modified Delphi methodology, involving a multiphase process that integrated literature reviews, content analyses, and expert consensus from top-performing organizations. Key findings reveal that top-performing organizations employ centralized goal setting with decentralized responsibility for implementation, fostering shared accountability at all levels. Horizontal integration underscores the multidisciplinary nature of top-performing quality departments, integrating diverse functions such as patient safety, infection control, and data analytics. Adaptability is an essential factor, with organizations incorporating evolving functions like ambulatory care and analytics, reflecting the dynamic needs of health care systems. By embracing adaptable, integrative, and balanced frameworks, organizations can position themselves to respond effectively to emerging challenges, maintain operational efficiency, and uphold high standards of care delivery.
Am J Med Qual
· 2025 Nov-Dec 01 · PMID 40704785
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The HFACS framework demonstrated strong reliability in identifying systemic weaknesses within orthopedic surgical workflows. These findings emphasize the urgent need for structured interventions that reduce distractions,...The HFACS framework demonstrated strong reliability in identifying systemic weaknesses within orthopedic surgical workflows. These findings emphasize the urgent need for structured interventions that reduce distractions, improve team communication, and regulate vendor interactions in the operating room, all essential steps toward advancing safety and enhancing overall patient care quality.
Kharasch M, Fazio LT, Rosca T
… +3 more, Schindler N, Fisher SG, Halasyamani LK
Am J Med Qual
· 2025 Nov-Dec 01 · PMID 40605176
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In an effort to provide comprehensive and consistently high-quality health care, the need to address professional behavior is rising. The physician conduct program was designed to reduce physician conduct concerns while...In an effort to provide comprehensive and consistently high-quality health care, the need to address professional behavior is rising. The physician conduct program was designed to reduce physician conduct concerns while providing an organizational culture in which physicians would thrive. This program includes a trained team, an event-reporting system, and a physician advisory council. Root causes, perspectives, and corrective strategies for each reported incident are explored with identified individuals in each incident. Over the 4 past years, complaints (n = 583) have included: rude or disrespectful comments to colleagues (52%), lack of physician communication with colleagues (15%), disrespectful interactions (23%) and inadequate communication with patients (5%), and violation of organizational policies (5%). The professional conduct program has provided a cohesive, systematic resource aligned with the health system's focus on teamwork, collegiality, and excellence in patient care.
Coons J, Singla V, White E
… +5 more, Byers E, Dueweke E, Mulukutla S, Solano F, Jain SK
Am J Med Qual
· 2025 Nov-Dec 01 · PMID 40528318
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Atrial fibrillation is a prevalent condition, which is an independent risk factor for ischemic stroke. Anticoagulation is widely used to mitigate stroke risk but remains underprescribed in certain circumstances. The auth...Atrial fibrillation is a prevalent condition, which is an independent risk factor for ischemic stroke. Anticoagulation is widely used to mitigate stroke risk but remains underprescribed in certain circumstances. The authors evaluated the performance of a health record database query in identifying patients who may benefit from anticoagulation who did not have an active prescription for anticoagulation. Patient charts were reviewed by primary care providers and reasons for deferral of anticoagulation were provided. A subset of the patients identified were found to not have an appropriate reason for deferring anticoagulation. This initiative ultimately led to an increase in referrals to the center for specialty care of atrial fibrillation.
Wilson AM, Berg K, Douglas A
… +6 more, Caruso J, Diemer G, Day K, Frasso R, Herrine SK, Abraham D
Am J Med Qual
· 2025 Sep-Oct 01 · PMID 40505090
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This study identified a method for assessing the alignment between undergraduate medical education program learning objectives and graduate medical education program competencies. Using a modified Delphi approach in whic...This study identified a method for assessing the alignment between undergraduate medical education program learning objectives and graduate medical education program competencies. Using a modified Delphi approach in which the number of rounds (3) and consensus (70% agreement) were determined a priori, the study sought to align objectives and competency measures between the programs. The authors invited panelists from Sidney Kimmel Medical College at Thomas Jefferson University to independently respond to a questionnaire via an email invitation. In the questionnaire, panelists made 46 decisions about the alignment between the undergraduate medical education program learning objectives and the Accreditation Council for Graduate Medical Education Harmonized Milestones subcompetencies. Approximately, 57% (26/46) of the decisions reached a consensus that there was an alignment between the objectives and the subcompetencies. By aligning the objective and subcompetencies, this study provided a first step toward closing the gap in the communication of student competencies.
Wolf JS, Whitney ML, Summey RM
… +9 more, Sanchez MP, Rose DT, Rosalsky MB, Lara ST, Daley MJ, Coopwood B, Carter BG, Ashour RR, Mette JE
Am J Med Qual
· 2025 Sep-Oct 01 · PMID 40359256
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Using data from the National Surgical Quality Improvement Project (NSQIP), we aimed to reduce the incidence of postoperative sepsis, focusing on patients receiving red blood cell (RBC) transfusions and with open wounds....Using data from the National Surgical Quality Improvement Project (NSQIP), we aimed to reduce the incidence of postoperative sepsis, focusing on patients receiving red blood cell (RBC) transfusions and with open wounds. We postulated that diverse countermeasures would reduce postoperative sepsis. Workgroups were created around 4 problems with root causes identified using standardized processes: excessive RBC transfusions, owing to transfusing for Hb > 7 or > 1 unit at a time; infrequent use of cell salvage due to knowledge deficit or cell salvage machine not available; incorrect antibiotics owing to penicillin-allergic patients not getting cephalosporins or patients getting empiric antibiotics to which organisms are resistant; suboptimal postoperative wound management owing to poor communication regarding care plans and care transitions. Thirteen countermeasures were implemented. With improvement in 7 of 8 process metrics, the rate of postoperative sepsis declined from 1.56% (tenth decile performance in the NSQIP database) to 0.59% (first decile), P = 0.0065.
Asche SE, Chrenka EA, Dehmer SP
… +5 more, Ziegenfuss JY, Werner AM, Swiontkowski MF, Reams M, Solberg LI
Am J Med Qual
· 2025 Sep-Oct 01 · PMID 40314470
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The impact of providing comparative individual surgeon performance feedback on outcomes has received little attention. The objective was to determine whether repeated distribution and discussion among orthopedic surgeons...The impact of providing comparative individual surgeon performance feedback on outcomes has received little attention. The objective was to determine whether repeated distribution and discussion among orthopedic surgeons of their own customized comparative surgeon performance feedback concerning Patient-Reported Outcome Measures, implant costs, and procedure time had an impact on these same outcomes, surgeon rating, and procedure time. This quality improvement initiative utilized a single-group interrupted time series design evaluating pre- to postexposure to surgeon feedback reports for surgeries in 2236 total knee arthroplasty and 1582 total hip arthroplasty patients to assess differences in implant costs, procedure time, change in patient-reported Oxford Knee/Hip Scores, surgeon rating after surgery, and shared decision after surgery. There was no consistent evidence that the receipt and discussion of comparative surgeon performance feedback by surgeons resulted in improvement in the outcomes considered.