Quality Improvement

Quality Improvement in Healthcare

Michigan hospitals were among the first to heed the call for greater patient safety and quality. Today, there is a new reality: one of clinical empowerment through large-scale collaboration. Doctors, nurses and hospital leaders voluntarily identify and share best practices with their colleagues around the state, nation and world to ensure patients receive the best care possible. The MHA Keystone Center is involved in various quality improvement activities, most recently as a Network of Quality Improvement Innovation Contractor (NQIIC) under the Superior Health Quality Alliance.

The MHA Keystone Center is one of eight organizations that created the Superior Health Quality Alliance (Superior Health) to improve the quality of health and healthcare through innovation, effectiveness and efficiency in designing and implementing initiatives that are person-centered and integrated across the continuum of care and services.

In February 2019, Superior Health was named as an NQIIC by the Centers for Medicare & Medicaid Services (CMS).  In November, it was awarded a five-year contract to serve as a Quality Innovation Network – Quality Improvement Organization in Michigan, Minnesota and Wisconsin. The work under the contract focuses on improving nursing home quality, increasing quality of care transitions, increasing chronic disease prevention and self-care, increasing patient safety, and improving behavioral health and opioid misuse.

Superior Health members include the Illinois Health and Hospital Association, MetaStar, the Midwest Kidney Network, the Minnesota Hospital Association, MPRO, Stratis Health and the Wisconsin Hospital Association. Under Superior Health, the MHA Keystone Center continues to implement the innovations necessary to prevent harm, save lives and lower healthcare costs.

To address the needs of the rapidly growing older population, the MHA Keystone Center launched its first Age-Friendly Health Systems Action Community in October 2019.

The initiative, funded by the Michigan Health Endowment Fund, brings attention to adults 65 years and older by focusing on the 4Ms framework for creating age-friendly environments.

  • What Matters to the patient/family.
  • Medication – using age-friendly medications that don’t interfere with mobility, mentation or what matters.
  • Mentation – preventing, identifying and treating conditions like dementia, depression and delirium appropriately.
  • Mobility – ensuring older adults move safely every day to maintain and improve function.

The MHA Keystone Center Age-Friendly Health Systems Action Community replicates the work initially launched in 2017 by the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States. Five health systems nationwide — including Michigan-based Trinity Health — participated in the prototype, with an overall goal to support 20 percent of U.S. hospitals becoming age-friendly by June 30, 2020. Results nationally have confirmed that this model can improve care experiences and outcomes, as well as lower care costs.

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 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 unite with MI AIM to work as a single quality improvement initiative for all Michigan birthing hospitals. 

This partnership strives to decrease maternal mortality and morbidity in Michigan by working with birthing hospitals to implement the AIM Obstetric Hemorrhage and Severe Hypertension in Pregnancy safety bundles. These bundles help improve health outcomes for mothers by combating the leading causes of preventable maternal mortality. Safety bundles help equip hospitals with influential protocols, necessary equipment, employee education and employee drills to prevent and adequately treat severe maternal events.

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.

In 2018, the MHA Keystone Center partnered with Vlasic & Roth LLC. The Birmingham-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 to 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. It 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 combines virtual or in-person training and 1:1 coaching. The various teaching styles helps 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 a long-lasting change in human behavior is one of the greatest leadership challenges for healthcare professionals. An estimated 70% of initiatives that require a 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.

The MHA Keystone Center is preparing for future cohorts of the Implementation Science: Healthcare Performance Improvement Certification Course. Please check the MHA Member Portal for an up-to-date listing of events.

In September 2016, the MHA Keystone Center was awarded a Hospital Improvement Innovation Network (HIIN) contract by the CMS.

The MHA Keystone Center partnered with the Illinois Health and Hospital Association (IHA) and Wisconsin Hospital Association (WHA) to form the Great Lakes Partners for Patients (GLPP) HIIN. Its goal was to reduce 14 hospital-acquired conditions (HACs) by 20 percent and readmissions by 12 percent, from a 2014 baseline.

After three and a half years of quality improvement work, the GLPP HIIN can share the many successes 316 hospitals across Illinois, Michigan, and Wisconsin achieved during this period. As a network, the GLPP HIIN saw a total cost savings of $292,903,501, saved 3,350 lives and avoided 25,204 incidents of harm within hospitalized patients. GLPP HIIN hospitals also increased person and family engagement practices and addressed health disparities.

The GLPP HIIN partnership built on the quality improvement work of the IHA, MHA, and WHA through the CMS national Partnership for Patients Hospital Engagement Network (HEN) 1.0 and 2.0, contracts awarded from 2011 to 2015.

While work from the HIIN concluded on March 31, 2020, the MHA Keystone Center continues to focus on sustaining and accelerating national progress and momentum toward harm reduction and reducing health disparities.

The MHA Keystone Center brings together hospitals and state and national quality experts for various events throughout the year. These workshops, meetings and training events share evidence-based best practices to improve patient care and reduce healthcare costs.


Simulations provide hospitals the opportunity to walk through their 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 topic-specific interactive event that provides the current best practices, discuss techniques, share success stories, and express areas of opportunity within their organizations.

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 used as a follow-up to a previous meeting.


Content experts are invited to share various ‘hot topics’ via a webinar hosted by the MHA Keystone Center. Each event includes a question-and-answer period at the end and is 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 problems and work to address them through their quality improvement skills. IANs are approximately 3 to 4 months and require a commitment on behalf of the hospitals to dedicate staff time and resources to virtual or face-to-face events and follow-up calls. Hospital teams also complete a Gap Analysis on the corresponding area of harm, to help identify their areas of greatest opportunity and where to begin their improvements.

Site Visits

The MHA Keystone Center has partnered with consultants, with diverse 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 an 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 implement change best.