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Keystone ICU Project

Harnessing the Potential of Health Care Collaboratives

The below content is taken from the Goeschel and Pronovost article 'Harnessing the Potential of Health Care Collaboratives: Lessons from the Keystone ICU Project'. A link to the full article can be found at the bottom of the page.

In October 2003, the Quality and Safety Research Group of the Johns Hopkins University School  of Medicine, the Michigan Health and Hospital Association, and 108 intensive care units (ICUs)  from 77 hospitals began a collaborative improvement project. Goals to improve care included creating a culture of safety, reducing central line-associated bloodstream infections (CLABSI) and ventilator associated pneumonias (VAP), and improving compliance with evidence-based practices for ventilator care. Improvement teams were assembled in each ICU to do the work, and the chief executive officer of each hospital partnered to support project efforts. The teams achieved a 50 percent improvement in safety climate, attained a median CLABSI rate of zero, and reported 99 percent compliance with evidence-based ventilator care practices. Understanding how and why this collaborative succeeded may expedite progress in other improvement efforts. In this article we present some of the lessons we learned while leading the Keystone ICU project. 

The study offers the following lessons, not as an exhaustive list, but as a starting  point for others to consider when embarking on a large-scale initiative:-

  • Understand the Differences Between Leadership and Authority: Cultivate Leaders  
  • Get Both the Technical and Adaptive Work Right
  • Strive to Find the “Sweet Spot” Between Scientifically Sound and Feasible Interventions and Measures 
  • Match Project Goals, Objectives, and Database Design from the Outset 
  • Stay Focused on Original Aims
  • Link Culture Improvement and Clinical Outcomes 
  • Minimize the Bias in Data Collection 
  • Reduce the Quantity, Not the Quality, of Data
  • Keep a “Laser-Sharp” Focus on Patients 
  • Expect the Project to Stall at Times 
  • Improve Upon Quality Improvement Models


Resources are too scarce and the need to improve is too great to support quality improvement activities that are inefficient or ineffective. Project coordinators should strive to make certain that frontline wisdom is respected and reflected in the work; that resources needed to conduct the  work are part of leadership’s commitment to participate, a commitment that must be honored;  and that the impact of each intervention is measured in a manner that will allow the industry to  understand whether clinical outcomes improved and whether patients are safer because of our  efforts. 

Full Article