Across the US, a healthcare quality phenomenon is occurring. The senior leaders of more than 2,000 hospitals (a third of all US hospitals) have publicly signed up to a campaign organised by the Institute of Health Improvement.

The aim is bold: to save the lives of 100,000 people who would otherwise die as a direct result of their stay in hospital. This is a country where competition for patients is fierce, litigation is rife and reputation is everything. Yet by signing up to the campaign, these hospitals are publicly admitting that their patients are dying unnecessarily and are pledging to do something about it.

The platform of the campaign is a package of six evidence-based interventions that are known to improve overall hospital mortality.

The first change is to deploy rapidresponse teams to bring critical care expertise to patients whose condition is deteriorating anywhere in the hospital.

The institute suggest this change could see a 12.5 per cent decline in mortality in an average US hospital, which equates to 115 lives saved per year. The second change is a set of actions to bring about a 40 per cent reduction in inpatient deaths from heart attack. This might save 108 lives per year.

The next three changes are about improving the reliability of specific interventions: preventing ventilatorassociated pneumonia (could save 72 lives), central venous line bloodstream infection (16 lives) and surgical site infection (13 lives). The final change seeks to prevent adverse drug events by ensuring that patients receive all intended medication when they are transferred from one care setting to another. A 10 per cent reduction in the error rate would save one life per year.

These calculations suggest that by focusing on these changes, 25 per cent of these deaths could be prevented. Each hospital would need to achieve a small proportion of the potential to save 100,000 lives across the country.

Implementation is based on a series of 'nodes' - organisations that have volunteered to co-ordinate networks of 30-60 participating hospitals.

Thousands of hospital leaders have been participating in telephone conferences and are making use of the campaign materials that the institute is providing free of charge.

We have knowledge in the NHS that, if spread systematically across the country, would bring significant gains in clinical quality. Yet there is great variation in the extent to which that knowledge is implemented. The campaign approach potentially offers a fresh perspective on enabling change.

First, it frames the quality proposition in a compelling way with which people connect at a personal level, in line with their individual values. Who among the clinical and managerial community is not moved by an appeal to save lives?

Second, the campaign offers a way to make a difference through the platform of six high-impact changes and help with implementation planning.

Third, the campaign enables people to demonstrate courage as part of a wider movement for good. Few individual leaders would take the risk of publicising unnecessary deaths at their hospitals. Yet if you are part of a national movement where hundreds of your peers are doing the same, endorsed by the most powerful bodies in American healthcare, the risk seems much less and the motivation to challenge the status quo much more compelling.

And perhaps the hospitals participating in the campaign are making a smart strategic move to differentiate themselves in their marketplaces. As a consumer of healthcare in a world of competition and choice, I would want to go to a hospital where there was less chance of dying.

Helen Bevan is interim director of the new Modernisation Agency.

-www. ihi. org/IHI/Programs/Campaign

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