'What can the NHS learn from this overachievement of a national goal?'

In an earlier column I wrote about a bold campaign in the US, initiated by the Institute for Healthcare Improvement, whose mission was to save the lives of 100,000 people who would otherwise have died in hospital over a period of 18 months (Good Management, page 31, 23 June 2005).

The campaign was based on six evidence-based interventions that save lives and reduce hospital mortality rates. The first was deployment of rapid response teams to bring specialist expertise to patients whose condition was deteriorating anywhere in the hospital. The second was a set of actions to reduce hospital deaths from heart attacks. The next three reduced hospital-acquired infections, ventilator-associated pneumonia (VAP) and central line and surgical site infections. The final intervention sought to prevent adverse events through reconciliation of patient medication.

The 18 months ended on 14 June. The official estimate of lives saved was 122,342. The sign-up rate was phenomenal: 3,103 hospitals enrolled in the campaign, representing more than 80 per cent of all discharges and over 75 per cent of all acute care beds in the US.

Commentators believe that the 100,000 Lives Campaign has changed the standard of care in the US. The list of hospitals that have not had a single case of VAP or a central line infection for at least 12 months is growing. The outcomes are starting to challenge conventional views about the inevitability of healthcare-associated infections.

So what can the NHS learn from this overachievement of a national improvement goal?

First, quality specifications and clinical standards are not enough on their own to engender wholesale change. They create a 'push' effect - an externally driven dynamic that tells providers what they should do.

The 100,000 Lives Campaign demonstrated the power of the 'pull' approach. It framed the change proposition as an irresistible emotional and logical argument that fits with the values, beliefs and life experiences of clinicians and managers.

The campaign suggests new methods for ensuring spread and adoption of best practice. Campaigns are emergent, self-fuelling and bottom-up, yet success depends on meticulous planning and strategy. You have to design for pull as much as for push.

The campaign perspective challenges much of the way we have learned to organise and lead change in the NHS. We need to move beyond the push of the top-down performance improvement approach and beyond the unco-ordinated pull of lots of individual local projects. For instance, the campaign's focus on mobilisation, evidence-based interventions and frontline action could help give real teeth to practice-based commissioning.

The message of a life saved is a compelling rallying call. Yet the impact of the 100,000 Lives Campaign is beyond measures of clinical quality. It is also a powerful strategy for redesigning cost and increasing value.

A recent report in the US showed that high-quality, reliable clinical processes cost less to provide. This is in addition to lower mortality rates, fewer adverse events and fewer patient re-admissions.

The campaign is now moving forward. The next goal is full implementation of all six campaign interventions in all participating hospitals by January 2007.

How can we design our future improvement systems so staff at all levels can unite around specific aims and exceed national goals?

Helen Bevan is director of service transformation at the NHS Institute for Innovation and Improvement.