A successful quality approach involves everyone from the bedside to the boardroom to create a hospitalwide, patient-oriented culture. This, combined with a systematic approach to delivering care that is safe, effective, efficient, patient-centered, timely and equitable, is the heart of the American Hospital AssociationMcKesson Quest for Quality Prize.

While we have seen remarkable progress on these six Institute of Medicine quality aims, it is clear that safety and performance improvement is a journey that never ends.

On behalf of the Quest for Quality Committee, thanks to all the hospitals that applied for the 2012 awards and special thanks to those who hosted site visits. Collectively, you have raised the bar and demonstrated commitment. Here are some key learnings from the 2012 award process.

1 | Patient safety: A strong reporting system and "just culture" philosophy are only the beginning. A systematic approach that assesses risk by addressing potential hazards and probability of occurrence is vital. If root-cause analyses are done only in response to sentinel events and other major errors, you are missing important opportunities to make patient care safer. And storytelling, particularly by patients who have been harmed or by their families or by the involved staff member, is one of the most effective ways of getting the safety message to your staff.

2 | Equity: Understanding the disparities and needs in your community is the first step you can't address equity or measure progress if you are not starting with reliable and valid data. Look for community partners both in gathering data and in crafting solutions other hospitals, social service organizations, public health departments, schools, churches, etc. In addition, underserved groups need to feel welcomed at your hospital creating a diverse senior staff and C-suite, medical staff, workforce and governing board is an essential step. AHA's Institute for Diversity and Center for Healthcare Governance have resources to help hospitals and health systems.

3 | Leadership: Board leadership in safety and performance improvement is where everything starts. Engage your board members not only at their meetings, but also on performance improvement and safety committees and senior leadership walk-arounds. Make sure your board understands the impact of resource allocation decisions on patient safety and performance improvement and champions investments in quality and safety.

4 | Spreading improvements throughout the organization is challenging: Everyone has to be on board, with protocols and pathways hardwired. Celebrate successful results and remember that when clinicians see a better way that gets better results, they will opt for improvement.

The AHAMcKesson Quest for Quality Prize Committee congratulates the 2012 winner, University Hospitals Case Medical Center (Cleveland); the 2012 finalists, Lincoln Medical and Mental Health Center (Bronx, N.Y.) and University of North Carolina Hospitals (Chapel Hill); and the 2012 Citation of Merit honoree, Meriter Hospital (Madison, Wis.). More information on their quality journeys and the 2013 application can be found at www.aha.org/questforquality.

Jeffrey D. Selberg is executive vice president and chief operating officer of the Institute for Healthcare Improvement. He chaired the AHA-McKesson Quest for Quality Committee for the 2012 awards. Contact him atjselberg@ihi.org.

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