Peter J. Pronovost

Introduction: University Hospitals transformed its quality strategy by transitioning to Det Norske Veritas accreditation and seeking International Organization for Standardization (ISO) 9001 certification to support its zero-harm framework and establish a sustainable quality management system. Intervention: Through standardized governance, leadership engagement, risk-based thinking, internal auditing, and an ISO 9001 implementation toolkit, hospitals embedded continuous readiness, accountability, and improvement into daily operations while aligning board-level oversight with frontline practice. Closing gaps: Det Norske Veritas accreditation and ISO 9001 certification are not well-known models in the United States. This journey describes implementation of a scalable model, moving beyond episodic compliance to continuous learning and improvement.

Context: Diabetes mellitus is a global health burden, with factors contributing to its prevalence and costs. Educating people with diabetes improves outcomes and affects the economic burden on the individual and health systems. Evidence Acquisition: We included recent diabetes data from the Centers for Disease Control and Prevention and articles from PubMed and Ovid MEDLINE. Evidence Synthesis: Diabetes prevalence in the United States increased from 10.3% in 2001 to 14.7% in 2021. Factors contributing are an aging population, increased obesity, and social determinants of health. Total costs for diabetes in 2022 reached $412.9 billion, consisting of 74% direct medical and around 26% indirect costs. The highest medical expenses were hospital inpatient services ($96.2 billion), and indirect costs were decreased productivity while at work ($35.8 billion). The effect on the health economy in the United States and globally is only increasing. Interventions to improve disease outcomes such as diabetes education programs that teach self-management skills, healthy lifestyle behaviors, and coping strategies have improved glycated hemoglobin A1c and other outcomes. The economic effect of education is not well studied. However, the Diabetes Prevention Program demonstrated the benefits of lifestyle-based education in preventing or delaying the development of type 2 diabetes in high-risk people and in being cost-effective long term. Conclusion: High direct and indirect costs and the prevalence of diabetes require urgent global awareness and interventions from many angles. We encourage clinicians and agencies to prioritize the education of people living with diabetes to prevent and treat diabetes and its complications.

Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements. Design: Quality improvement with multiple levels of interventions Setting: A health system in northern Ohio with 21 affiliated hospitals across 16 counties. Patients: Adult patients admitted to the hospital between June 2020 and June 2023. Methods: A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023). Results: Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices. Conclusions: A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.