Linking and Aligning Inter-Professional Performance to Improve Sepsis Mortality throughout a 9-Hospital Collaborative

Purpose:
Literature often reports on organizations that successfully implement QI programs, without describing the programmatic approaches. The Integrated Nurse Leadership Program (INLP), is a program for improving outcomes, with a theoretical model of change of engaging an inter-professional team.

Significance:
Extant literature provides few validated frameworks for guiding clinical improvement, which leaves leaders of healthcare organizations with little guidance for replicating change. The INLP model has demonstrated sustained organization-wide improvements in medication error and sepsis reduction.

Strategy and Implementation:
INLP was developed by the University of California at San Francisco to improve nurses' and hospitals' capacity for improvement. Using an improvement collaborative approach, the INLP brings together teams of clinicians to transform the hospital work environment and improve patient outcomes in order to lead sustainable systems change. The program consisted of a collaborative involving nine hospitals. The INLP program addresses all levels of hospital personnel, including the C-Suite, second tier leadership including medical directors, nursing officers, and heads of patient care services as well as frontline clinicians. Designed to establish a “collaborative practice” model within hospitals, the INLP encouraged hospitals to adopt four common strategies to improve reliability in early identification and treatment of sepsis: sepsis screening of all patients, diagnostic testing according to protocol, timely treatment based on best evidence and ongoing data review.

Evaluation:
INLP achieved major reductions in sepsis mortality especially when compared to similar efforts . Mortality decreased 55.4%, using a two-sample t-test showing a 1% significance. Also achieved was improvement in substantial growth in the ability of hospitals to achieve quality improvement.

Implications for Practice:
INLP uses social determinants of behavior and socioadaptive elements beyond the “checklist” to forge new alliances with unfamiliar stakeholders. Achieving quality improvement is hard because it requires the front line clinician to become skilled at change management and become informal leaders.