Balancing Systems and Individual Accountability in a Safety Culture

But there is hope…• Baptist Memorial Hospital–Desoto (MS) IHI’s IMPACTICU collaborative• Infection rates fell• VAP (7.5 to 3.2 per 1,000 ventilator days)• BSIs (5.9 to 3.1 per 1,000 line days)*• The Michigan Health & Hospital Association (MHA)Keystone ICU project• 60% reduction in CLABSIs• Sustained at 36 months post-implementation of interventions***Jain M et al.: Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiativefocusing on teamwork and culture change. Qual Saf Health Care 15:235–239, Aug. 2006.**Pronovost PJ et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units:Observational study. BMJ 340:c309, Feb. 2010.9NPSF Professional Learning Series