An Overview of Quality with Renee Demski and Tiffany Callender

The Johns Hopkins Armstrong Institute for Patient Safety and Quality oversees, coordinates and supports patient safety and quality efforts across Johns Hopkins’ integrated health care system.

Our quality and safety goals are to reduce preventable harm, eliminate waste, and improve clinical outcomes and patient experiences. Alongside these goals, the Institute of Medicine—the national leader on health practices—has championed that quality improvement efforts should also be safe, timely, effective, efficient, equitable and patient-centered.

Johns Hopkins Medicine quality improvement teams work to ensure that our health system is providing care that aligns with these six aims, and they help us meet our quality and safety goals. This involves reporting progress on certain quality and safety measures and implementing improvement plans where we are providing less than excellent care.

Renee Demski, vice president of quality for The Johns Hopkins Hospital and Health System and the Armstrong Institute, focuses on the effective integration of quality services across the health care continuum for the Johns Hopkins Health System, with the goal of maximizing organizational improvement, efficiencies and the value of clinical services. Tiffany Callender is a quality and innovation project manager with the Armstrong Institute, working closely with hospitals across the Johns Hopkins Health System on quality improvement efforts. She also supports the organization in recognizing and preparing for trends in reporting quality and safety measures.

In today’s Ask the Expert, Demski and Callender share some important information about quality measures across Johns Hopkins Medicine. Submit your questions for an interactive Q-and-A with the experts on patient quality.


What are the quality improvement priorities within Johns Hopkins Medicine?

The Johns Hopkins Medicine Strategic Plan incorporates six priorities: people, biomedical discovery, patient- and family-centered care, education, integration and performance. Delivering patient- and family-centered care is the priority under which the quality and safety goals fall.

Goals within the patient- and family-centered care domain change slightly each year to reflect new milestones to improve care and current evidence-based best practices. Some of our fiscal year 2015 patient- and family-centered care areas of focus include:

  • Reducing the occurrence of hospital-acquired conditions and Maryland hospital-acquired conditions, such as pressure ulcers
  • Reducing the number of catheter-associated urinary tract infections
  • Increasing the number of patients who are screened for and appropriately receive venous thromboembolism prophylaxis

Priorities for fiscal year 2016 will continue to reflect areas of focus where we are striving to improve care and meet our quality and safety goals. While improvement projects occur continuously across the health system, Johns Hopkins Medicine’s systemwide effort to strategically improve quality of care and safety measures is supported by the institution’s national leader strategy.

What is the national leader strategy?

In 2012, Johns Hopkins Medicine set the ambitious goal to demonstrate national leadership in patient safety and quality. This decision, made by the Johns Hopkins Medicine Patient Safety and Quality board of trustees and leaders from across Johns Hopkins Medicine, has resulted in a systemwide commitment to meet specific goals to ensure our patients always receive the excellent care they deserve.

The national leader strategy provides a framework by which performance improvement efforts are executed across the Johns Hopkins Health System. The components of the framework and examples of each are:

  • Identify and communicate clear goals.
    • Example: Issue memos from leadership to all staff communicating measures of focus and performance targets.
  • Create infrastructure/build capacity.
    • Example: Launch systemwide work groups to allow hospitals to share areas of challenge and lessons learned in an effort to improve care on a particular measure.
  • Practice data transparency and reporting.
    • Example: Create and distribute a monthly report to regularly communicate performance to frontline staff and leadership.
  • Exercise accountability.
    • Example: Implement a quality and safety accountability plan that tracks performance each month and triggers action where measures are below target. The plan escalates up and is reviewed by the Johns Hopkins Medicine board of trustees, ensuring all levels of the organization are aware of challenges and are involved in the solution—from the “boardroom to the bedside.”
  • Emphasize sustainability.
    • Example: Develop sustainability plans documenting processes that have resulted in sustained, improved performance.

While the national leader strategy initially focused on core measures, bloodstream infections and hand hygiene, the strategy has expanded to include other key measures like surgical site infections, patient experience and hospital throughput. Also, although initially focused on inpatient measures, the national strategy now includes efforts in our ambulatory, pediatric, home health, population health and international settings.

How do quality and safety measures link to patient outcomes?

Quality and safety measures inform us of how well we are meeting our goals and gauge how well we provide standardized best practices for care that minimizes harm.

Quality of care can impact patient outcomes in many ways. For example, a patient who develops a pressure ulcer may require additional treatment during and after hospitalization. This may result in increased cost, increased length of stay and decreased quality of life. Following our quality and safety goal to eliminate harm, the most effective and patient-centered way to address pressure ulcers is to ensure practices are followed that focus on prevention and minimize the initial occurrence of the pressure ulcer.

Tracking our quality metrics and developing improvement plans that target key areas help to reach this goal.

What happens if my Johns Hopkins institution does not meet the new targets set forth in these measures? What happens if Johns Hopkins Medicine overall does not meet the new targets?

Many of the quality and safety measures we track are also linked to programs that provide financial incentives and penalties for exceptional or poor performance. While our quality improvement efforts are first and foremost intended to provide excellent patient care, performance on these measures can impact hundreds of thousands—if not millions—of dollars in each hospital’s budget. Loss of this money further impacts patient care, because it limits the resources and services we are able to provide to our patients.

How can I track my unit’s progress?

Committing to the Johns Hopkins Medicine quality priorities and knowing where your unit stands are important, as external agencies are adding new measures in the coming months.

To view your unit’s performance, visit the internal, systemwide quality and safety dashboard at Here, you can drill down to your unit or department to see how your area measures up against organizational targets and peers across the health system.

Employees can use the dashboard to access a library of resources to help them improve and reach the organization’s goal to reduce preventable harm and optimize patient outcomes and experience while reducing health care costs. The dashboard can also be used to find out how patients rate their experience and how often standardized best practices of care are used to prevent infections and other complications.

How can I become more involved in quality improvement initiatives at Johns Hopkins Medicine?

As employees of Johns Hopkins Medicine, we all have the ability and responsibility to ensure our patients receive the safest and highest quality of care possible. For Johns Hopkins Medicine and our patients to thrive, we all must commit to quality.

Here are a few suggestions to become more involved in quality improvement efforts:

  • Connect with your organization’s quality department to learn more about local efforts.
  • Join an existing group, such as a core measure work group or a clinical community, to help us develop and implement interventions and accountability plans and streamline processes to improve quality at the local and larger health system levels.

The Armstrong Institute also offers numerous opportunities, including trainings, workshops, fellowships and certificate programs, for the Johns Hopkins community to deepen its involvement in quality improvement initiatives. To learn about the institute’s programs and how you can become more involved in patient safety initiatives across Johns Hopkins Medicine, visit



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