Skip to cookie consent Skip to main content

Saving More Lives Through Teamwork, New Approaches

6 minute read

Over the course of a given week, for 15-20 minutes at a time, Mass General Brigham nurses, advanced practitioners and doctors gather in units and clinics for regular high reliability organization (HRO) quality rounds. During these huddles, care team members are empowered to speak up—to identify challenges or problems that might get in the way of their ability to meet our patient care goals.

A nurse leader points to patient care metrics at a recent HRO quality huddle at Brigham and Women’s Hospital

On posters and video screens, scorecards show key metrics, including patient experience scores, length of stay, healthcare-associated infections and mortality. These data points are displayed in either red or green, indicating whether a unit is meeting its target in that area. The team reviews the metrics, discusses improvement strategies and then develops and tests interventions to enhance care. Because the rounds are weekly or every other week, teams can regularly pilot solutions and evaluate their success using new skills in standardized process improvement everyone is learning.

“Our goal is to build a high reliability organization and culture where everyone is proactively identifying risk and helping us to continuously improve,” Madonna Cruz, MAN, RN, a nursing director at Salem Hospital, recently told huddle participants. “We want to hear from you about what you’re seeing on the front line.”

By now, the huddles may seem routine for some clinicians, but the approach represents an exciting new step for Mass General Brigham, as we become a high reliability organization, empowering care teams to drive improvement that will help us become the leading health system in the country for quality. This work is playing out everywhere: from inpatient units at our academic medical centers (AMCs), to community hospitals, to primary care clinics.

It's all part of a systemwide shift that is redefining how Mass General Brigham improves care for every patient. This shift, clinical leaders say, is historic, and could have a uniquely powerful impact for our clinicians, staff, and most importantly, our patients.

Clinicians discuss patient care at a recent HRO quality huddle at Massachusetts General Hospital.

“We are in the midst of an enormous transformation,” said Jose Florez, MD, PhD, Chair of the Department of Medicine at Mass General Brigham. “I’ve been here for over 25 years, and there’s been a number of initiatives [during that time]. I’m not sure there are many I can count that have had the transcendental impact that this is likely to have when we expand it across the entire system.”

Early results are promising: Our AMCs have seen the rate of observed-to-expected mortality drop precipitously, outpacing the national AMC peer composite benchmark, and placing us in the top tier of AMCs nationally, representing over a thousand lives saved. Similar progress is evident for our community hospitals. These data continue to change each month, but the long-term trend in the past two years demonstrates the success of our unified approach.

Clinicians gather at a recent HRO quality huddle at Brigham and Women’s Hospital.

Leaders note that improvement takes sustained efforts, and we have much more work to do across all our metrics. “We have come a long way, but we’re kind of at a new starting line,” said Rebecca Cunningham, MD, Chief of Clinical Affairs and a primary care physician for Mass General Brigham.

She pointed to upcoming efforts to adopt the high reliability approach across care settings, “in a way that it’s not just new anymore, but it’s actually the way we do work everywhere.”

A team approach, scaled systemwide

Mass General Brigham first began to organize around a single approach to quality in early 2023, with the formation of a systemwide Office of the Chief Medical Officer. Foundational elements, like a unified measurement system for key quality metrics, were established. A single strategy, For Every Patient, was formally launched that spring, with targeted interventions to improve mortality—all to advance our goal to become the best system in the country for quality, measured this year by mortality improvement.

All these components, leaders say, are necessary to make meaningful progress. “With all teams across hospitals working together toward the same goal, we can make much more meaningful progress than when everyone is working independently, with different priorities, goals, strategies and measurement,” said Tom Sequist, MD, MPH, Chief Medical Officer, Mass General Brigham and a primary care physician at Brigham and Women’s Hospital.

This approach has continued in recent months. Mass General Brigham’s Early Warning System launched in full this year, using real time Epic data and clinical observations to identify patients very early on whose clinical status might be worsening. This allows our care teams to deliver interventions faster to improve outcomes, while better clinical documentation is deepening our understanding of our patient population so we can provide better care.

We are in the midst of an enormous transformation…. I’m not sure there are many [initiatives] that have had the transcendental impact that this is likely to have when we expand it across the entire system.

Jose Florez, MD, PhD

Chair, Department of Medicine

Mass General Brigham

Clinicians gather at a recent HRO quality huddle at Salem Hospital.

As our academic departments come together, they are naming single leaders to drive this work who will work closely with the systemwide quality leadership team, elevating priorities from each department and leveraging expertise and resources to drive improvement.

Quality, though, remains everyone’s responsibility across the system, and our HRO approach is engaging frontline clinicians and care teams to work together on unified priorities that advance us toward our quality goal.

The key to the approach, leaders say, is that the HRO model empowers clinicians to identify challenges and solve problems, working hand-in-hand with leadership on shared goals that make a meaningful difference in the lives of our patients.

“I think our teams are really excited about participating in this,” said Julia Mason, DNP, MBA, RN, CENP, Chief Nursing Officer at Brigham and Women’s Hospital. “This is about empowering our frontline staff, because everyone is focused on the shared mission of excellent patient care.”

Learn more about For Every Patient