Hospital-Based Medicine: Equipped for Quality Improvement

Johns Hopkins Community Physicians’ (JHCP) hospitalists see a wide range of patients at Johns Hopkins Medicine’s various hospitals; in fact, they are touch points for nearly every patient that passes through the Johns Hopkins Health System’s hospitals. In 2013, JHCP hospital-based medicine leadership wanted to develop a unified approach to measuring and improving quality for all hospitalists. They partnered with the Armstrong Institute for Patient Safety and Quality for guidance, and Project EQUIP (Excellence in Quality, Utilization, Integration and Patient care) was born.

Project EQUIP is a collaborative effort that reaches across five Johns Hopkins Medicine-affiliated hospitals: The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center (JHBMC), Howard County General Hospital, Sibley Memorial Hospital and Suburban Hospital. The goal is to engage all departments that feed into hospital-based care to evaluate and develop quality improvement initiatives.

Pat Wachter, administrator for JHCP’s hospital-based medicine program and a lead for Project EQUIP, says that the program is unique because it is truly from the ground-up. “To me, that’s the most important piece,” she says. “It involves the people who honestly and sincerely do the work. It makes them dedicated to the cause — and we really do move the needle.” The steering committee for the program, consisting primarily of unit directors, meets biweekly to review detailed data and executive requests, but every other week, front-line workgroup members come together to brainstorm ideas for how to improve metrics like length of stay, mortality and readmissions. Departments involved include case management, physical therapy, occupational therapy, respiratory therapy and many others — “anyone who affects how providers move through the continuum of care throughout our hospitals,” Wachter says.

According to Wachter, a significant improvement to the program came in fiscal year 2020: Project EQUIP gained its own data analyst, Gurmehar Singh Deol, project manager for hospital-based medicine at JHBMC. He has made it possible to create individual provider dashboards — the biggest asset to the program, in Wachter’s opinion. Individual providers are able to benchmark their performance, which leads to tangible data and outcomes. Hospitalists know that the data they are seeing is specific to them — rather than the hospital as a whole. “That’s a lot of the reason why it’s gained so much credibility among providers — because they know that it’s their data,” she says.

Eric Park and Atul Rohatgi, co-leaders for Project EQUIP at Suburban Hospital, could not agree more. Says Park, “The forum is a springboard for launching many of our quality improvement and quality assurance projects. It allows us to make sure that we are continuing to challenge ourselves to do better, and to maintain what we are already doing well.” Rohatgi has similar sentiments. Provider-specific dashboards indicate opportunities for change. A major takeaway, in his opinion, is that people who are doing well in specific domains can offer insights and share ideas with others for how they can improve. “When we learn from each other, we can raise the overall quality of our care,” Rohatgi says.

Before these individual dashboards were created thanks to Project EQUIP, hospitalists would have found it difficult to pull together their performance data from multiple sources. “Within the last year, the way data is visually aggregated for easy consumption and the automatic updates in the background has changed our practice for the better,” Park added.

This specific data and inter-entity collaboration are the heartbeat of Project EQUIP. Explains Wachter, “It brings us all together as providers and support staff with a common goal: taking care of patients. It doesn’t matter what entity or department you’re a part of we work as one."