Massachusetts General Hospital: Investing in Structure to Improve Quality


 Massachusetts General Hospital's name is synonymous with quality, and for good reason. The hospital has put plenty of thought into how best to organize every aspect of its organization to reflect quality, safety and clinical excellence.

When the infamous 1999 Institute of Medicine report, "To Err is Human," appeared, MGH took it seriously, creating a board of trustees subcommittee focused on quality and patient safety. In addition, the hospital made quality a first priority, setting policies to ensure quality and safety were regularly discussed at board meetings and among the highest leadership of the institution.

MGH's commitment to quality goes even further, according Elizabeth Mort, MD, senior vice president of quality and safety and CQO at MGH. Since the early 2000s, President Peter Slavin, MD, has started every meeting with the chiefs and executives with information about quality and safety. "This has persisted so that every single chief understands it is the most important thing in this situation," says Dr. Mort. 


Dr. Elizabeth Mort  

In the mid 2000s the hospital staged a retreat for senior managers at Harvard Business School, in which they analyzed quality progress improvement. The results of the retreat included a mission statement with a safety focus, developing credo and boundary statements for MGH employees and establishing the Center for Quality and Safety, and a C-suite level executive to lead it. "We established a new position reporting directly to the MGH president and the CEO of the physicians' organization, the senior vice president for quality and safety, which sent the message that quality and safety is important enough to act upon," says Dr. Mort, who is the second to occupy the position since its inception.

As a result of its rigorous quality leadership, MGH has put in place some remarkable programs, including a quality reporting program complete with quality chairs for each clinical department to ensure safety events are appropriately and quickly addressed. The just culture of the institution has allowed staff to make remarkable progress in trouble areas such as hand hygiene, which is consistently at 90 percent and is an initiative emblematic of MGH’s improvement culture, according to Dr. Mort.

MGH keeps quality consistent through conducting an annual institutional sweep for potential quality issues. After doing an internal audit, talking to affiliates and consulting national sources, the hospital creates a list of the top quality and safety issues. It then re-prioritizes its own projects based on this list. The process is one Dr. Mort calls critical for maintaining excellence.

In the end, she says, it all comes down to leadership, structure and communication. "You have to invest to get quality," says Dr. Mort, "and this is a good structure for which to do it." 


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