Quality Improvement in Healthcare

Michigan hospitals were among the first to heed the call for greater patient safety and quality. And today, there is a new reality: one of clinical empowerment through large-scale collaboration. Doctors, nurses and hospital leaders are voluntarily working to identify and share best practices with their colleagues around the state, nation and world to make sure patients are receiving the best care possible. The MHA Keystone Center in 2016 moved its quality improvement work under the Great Lakes Partners for Patients (GLPP) Hospital Innovation Improvement Network (HIIN) and Michigan Alliance for Innovation on Maternal Health (MI AIM) initivatives.

Vlasic & Roth

In 2018, the MHA Keystone Center partnered with Vlasic & Roth LLC. The Northville-based firm analyzes hospital data and provides methodologies and evidence-based interventions to drive high-impact, measurable and sustainable performance improvement. As part of the partnership, the Implementation Science: Healthcare Performance Improvement Certification Course is available all in the healthcare community. 

What is Implementation Science?

Implementation science is the study of how to transform evidence-based ideas into changes incorporated into everyday practice that improve healthcare outcomes. This involves assessing barriers to change, understanding the target group and setting, and selecting effective strategies and measures to change behavior.

Implementation Science: Healthcare Performance Improvement Certification Course

The Implementation Science: Healthcare Performance Improvement Certification Course will combine virtual training, in-person bootcamp and 1:1 coaching. The various teaching styles will help participants develop a strong foundation of theory while ensuring the new information is appropriately put into practice.  

Why Implementation Science?

Implementing a strategy that requires long-lasting change in human behavior is one of the greatest leadership challenges for healthcare professionals. An estimated 70% of initiatives that require change from front-line staff fail to produce results.

Implementation science provides healthcare teams the skills and tools to close the idea-to-implementation gap to attain solid execution of evidence-based practices for quality and performance improvement. This intensive training program will teach how to rise above the day-to-day grind and provide the necessary clarity, commitment, collaboration and accountability required for effective implementation.

Great Lakes Partners for Patients HIIN

Great Lakes Partners for PatientsIn September 2016, the MHA Keystone Center was awarded a two-year contract (with an optional third year based on performance) HIIN contract by the Centers for Medicare & Medicaid Services (CMS). 

Under the contract, the MHA Keystone Center partnered with the Illinois Health and Hospital Association (IHA) and Wisconsin Hospital Association (WHA) to form the GLPP HIIN to reduce hospital-acquired conditions (HACs) by 20 percent and readmissions by 12 percent, from a 2014 baseline.

The GLPP HIIN partnership will build on the quality improvement work of the MHA, IHA and WHA through the CMS national Partnership for Patients Hospital Engagement Network (HEN) 1.0 and 2.0, contracts awarded from 2011 to 2015. Over three years, GLPP HIIN hospitals will focus on implementing person and family engagement practices, enhance antimicrobial stewardship, build cultures of high reliability, reduce readmissions and address the following 11 types of inpatient harm:

  • Adverse drug events
  • Central line-associated blood stream infections
  • Catheter-associated urinary tract infections
  • Clostridium difficile bacterial infection, including antibiotic stewardship
  • Injury from falls and immobility
  • Pressure ulcers
  • Sepsis and septic shock
  • Surgical site infections
  • Venous thromboembolism
  • Ventilator-associated events
  • Readmissions

The focus on the GLPP HIIN’s work going forward will be to sustain and accelerate national progress and momentum toward continued harm reduction. Additionally, an essential element of this work is a commitment to improving health quality and organizations will give specific attention to identifying and reducing health disparities. 

The GLPP HIIN gives participating hospitals the opportunity to share solutions that have been successful in rural, urban and suburban communities across Michigan, Illinois and Wisconsin. The partnership allows us to continue implementing innovations necessary to achieve goals to prevent harm, save lives and lower healthcare costs.

MHA Keystone Center HIIN Events and Educational Offerings

The MHA Keystone Center brings together hospitals and state and national patient safety experts for various events throughout the year. These workshops, meetings and training events share evidence-based, best practices to improve patient safety and reduce healthcare costs. Additionally, the annual MHA Safety & Quality Symposium is another opportunity for healthcare leaders to learn and share patient safety and quality improvement initiatives.


Simulations are facilitated through MHA Keystone’s HIIN subcontractors, and provide hospitals the opportunity to walk through their own processes with Michigan’s safety and quality experts. Each simulation explores the hospital’s process, from a patient’s arrival to discharge, to better understand how to improve care.

Regional Learning Sessions (RLS)

A one-day interactive event that provides the most up-to-date best practices, and allows attendees to engage in discussion about techniques, share success stories, and express areas of opportunity within their organizations. MHA Keystone’s Regional Learning Sessions are topic specific, and have been held on Hospital Acquired Infections (HAI) and Antimicrobial Stewardship (AMS), to name a couple.

Quality Essentials Skills Training (QuEST)

A two-day, in-person workshop that engages hospital quality leaders and improvement teams in learning fundamental quality improvement skills, which will be utilized throughout the HIIN contract to drive improvement.

Coaching Calls

Coaching calls are held on a monthly or quarterly basis for up to 60 minutes each. Teams share their successes and barriers to implementing interventions and can ask questions and interact with colleagues to enhance learning and networking between hospitals. Coaching calls are done in conjunction with other events, and may be used as a follow-up to a prior meeting.


Content experts regularly host webinars throughout the year on various ‘hot topics’. Each event includes a question-and-answer period at the end and are accessible on the MHA Community site following the webinar, as a recording.

Improvement Action Networks (IANs)

IANs are a cohort of hospitals that have signed up to participate in an intensive coaching program, to significantly improve one area of harm (e.g. readmissions, pressure injuries, etc.). Participating hospitals receive guided coaching in an individualized manner so they may better understand their problem and work to address it through use of their quality improvement skills. IANs are short in duration, usually between 3 to 4 months, and require a commitment on behalf of the hospitals to dedicate staff time and resources to the face-to-face event and series of follow-up calls and webinars. Hospital teams are also asked to complete a Gap Analysis on the corresponding area of harm, to help identify their areas of greatest opportunity and where they might begin with their improvements.

Weekly Pacing Events

The Centers for Medicare and Medicaid Services (CMS) Partnership for Patients (PfP) community holds a weekly pacing event for HIIN leadership, improvement advisors and hospitals. MHA Keystone shares the registration information for these events, each week, on the MHA Community Site. The topics discuss range from inpatient care topics, to staff safety, to outpatient and community partnerships.

Site Visits

The MHA Keystone Center has partnered with consultants, with varying expertise, to work directly with hospitals to drive improvement.  Each consultant works with a core team of individuals within the facility, based on the targeted topic, and plans a site visit specific to the needs of the hospital.  The consultants work to gain understanding of the organization’s data, practices, methodologies, implementation and culture and provide feedback, education and guidance to hospitals on their opportunities to drive improvement and ways to best implement change.  

Maternal Health Efforts

The MHA Keystone: Obstetrics (OB) collaborative was launched in 2009. The collaborative has focused on implementing best practices and timely interventions for elective induction of labor and elective cesarean birth, coordinating a safe progression of labor, promoting appropriate responses to fetal distress, reducing obstetrical hemorrhage (postpartum hemorrhage) and preeclampsia, implementing the Comprehensive Unit-based Safety Program (CUSP) and improving best practices for OB care.

Hospitals in Michigan are currently participating in two statewide initiatives — the Michigan Alliance for Innovation on Maternal Health (MI AIM) and the Obstetrics Initiative (OBI) — to address these disparities and reduce the risk of maternal death.

In 2016, the MHA Keystone Center announced a strategic partnership with the MI AIM to bring together resources to help reduce morbidity and mortality for moms and babies across the state. Under the partnership the MHA Keystone: Obstetrics (OB) collaborative unites with MI AIM to work as the single quality improvement initiative for all Michigan birthing hospitals. 

Between 2014 and 2017 in Michigan, efforts of the MI AIM decreased:

  • Severe maternal morbidity by 10.5%.
  • Complications from hemorrhage by 19.6%.
  • Maternal hypertension complications by 19%.

In addition to serving as a partner organization in MI AIM, the MHA Keystone Center supports the effort by collecting process and outcome data from Michigan birthing hospitals. There are currently 48 Michigan hospitals actively engaged in the initiative.

OBI is a Blue Cross Blue Shield of Michigan-funded interdisciplinary quality initiative that engages maternity care providers and hospitals in a collaborative effort to safely reduce the use of primary cesarean deliveries for low-risk pregnancies in Michigan hospitals.

Reports & Publications

MHA Keystone Center Annual Report

MHA 100 Year Anniversary

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