For years, many hospitals have looked to improve quality and patient safety through the development of best practices — a process that usually brings together a multidisciplinary team to identify a specific shortcoming in a particular unit, assess the root causes and develop a solution. If the effort is successful, the best practice is spread throughout the hospital, and is sometimes adopted by other providers.

But Mark Chassin, M.D., president of the Joint Commission, believes it might be time for hospitals to move away from best practices and develop comprehensive, "robust process improvement" tools — which can include Lean, Six Sigma or other methodologies — that allow for deeper, more specific analyses of their patient safety needs. For instance, Chassin says, issues like hand hygiene or wrong-site surgery may have as many as 25 causes of failure, and each hospital may struggle to overcome a unique set of obstacles.

"The four or five causes of failure that explain the majority of failures in one place are very different when you go to the next hospital," Chassin says, and best practices must be applied accordingly. "If you don't have hand gel dispensers in the right place, it doesn't matter how much hand gel you buy."

Hospitals that focus more directly on continuous process improvement, Chassin says, can begin to adapt the principles of so-called high reliability organizations, which create tightly defined feedback loops that encourage employees to report minor problems before they rise to the level of errors or lapses in the quality of care provided.

While the Joint Commission currently requires hospitals to establish a culture of safety as part of its accreditation process, Chassin is hoping the institution's Center for Transforming Healthcare will play a greater role in encouraging hospitals to develop broad process improvement strategies.

"The three critical changes health care organizations have to undertake are a leadership commitment to zero major quality failures, the full embodiment and implementation of safety culture and the full deployment of robust process improvement," Chassin says. "We're working on very specific programs and strategies to give to organizations ... so they can make progress across those different domains."