Delivering safer, more reliable and more efficient care to patients and communities is the core mission of hospitals across the country. To improve patient safety and reduce harm, hospitals are employing new technologies, techniques and research, as well as collaborating with and learning from one another.

Hospitals must adapt to a rapidly changing health care landscape: implementation of the Affordable Care Act and efforts to bend the health care cost curve, onset of inpatient prospective payment system legislation, value-based purchasing and nonpayment for "never" events. With current delivery system and payment reforms serving as another impetus for change and continuous improvement in health care, it has become imperative that all hospitals learn the fundamentals for rapidly changing their processes to reduce harm and costs and then spread this change throughout their organizations.

Hospitals have been making great strides in improving patient outcomes. The Health Research & Educational Trust leads one of the Hospital Engagement Networks funded by the CMS Center for Medicare and Medicaid Innovation. The HENs are proving to be a tremendous support for hospitals. The AHA/HRET HEN provides education, resources, webinars and the Improvement Leader Fellowship to support 31 state hospital associations and 1,600 hospitals in their quest to achieve rapid improvement across 10 areas of patient harm: (1) adverse drug events, (2) catheter-associated urinary tract infections, (3) central line-associated bloodstream infections, (4) injuries from falls and immobility, (5) obstetrical adverse events/early elective deliveries, (6) pressure ulcers, (7) preventable readmissions, (8) surgical-site infections, (9) venous thromboembolism) and (10) ventilator-associated pneumonia/ventilator-associated events. The overall goal for all HENs is to achieve a 40 percent reduction in all harm areas and a 20 percent reduction in readmissions. Every hospital in the AHA/HRET HEN continues to drive toward these goals in reducing harm and readmissions.

While work remains, by forging effective strategies and sharing what they have learned, hospital leaders have spurred notable improvements in reducing harm, improving both care delivery and patient outcomes at the national, state and regional levels. These efforts have led to better quality and patient safety, as well as reduced health care costs. Topic-specific checklists, cost calculators and best-practice sharing are key in assisting hospitals working on rapid process change. Hospital culture, senior leadership, physician champions and patient and family engagement are fundamental building blocks for the work.

Our HEN's greatest accomplishment to date is the impact we are having on patients and their families. By reducing harm — preventing a patient from falling and breaking a hip, for example — we have been able to provide a safer environment for recovery and reduce unnecessary complications.

While hospitals may be at different points on their improvement journey and may employ slightly different approaches and models of quality improvement, all hospitals are committed to continuous quality improvement and are moving in the direction of reducing patient harm. To learn more about the AHA/HRET HEN and available resources, please contact your state hospital association HEN lead, email us at or visit our website at

Charisse Coulombe is senior director of the AHA/HRET HEN. She can be reached at

On the Web

Patient safety checklists

The Hospitals in Pursuit of Excellence guide "Checklists to Improve Patient Safety" is a compilation of checklists, all developed by Cynosure Health, to prevent patient harm in 10 areas. These areas include adverse drug events, catheter-associated urinary tract infections, central line-associated blood stream infections, injuries from falls and immobility, pressure ulcers, surgical-site infections, and obstetrical adverse events and early elective deliveries. Hospitals and health care systems that use checklists can reduce mortality, complications, injuries and other patient harm. This guide is available free of charge at

Value-based care

"Value-Based Contracting," a publication from the AHA's Health Research & Educational Trust and Kaufman Hall, provides specific guidance related to assessment, and financial, operational and implementation issues for health care providers transitioning to value-based care. The guide's primary audience is hospitals and health care systems, but much of the information also is applicable to physicians, physician groups and nursing facilities. Two recent webinars feature Kaufman Hall experts sharing insights from the guide. For free access to the webinars and guide, visit the Hospitals in Pursuit of Excellence website at The guide also is available at

Eliminating infections

Hospitals and care systems can eliminate catheter-associated urinary tract infections by using a two-pronged approach that combines best clinical practices with a strong culture of safety. "Eliminating Catheter-Associated Urinary Tract Infections" describes a three-step action plan to achieve and sustain reductions in CAUTI rates. Access the guide at Visit the CAUTI project website at