Lessons in cooperation: four hospital consortia relate their quality improvement experiences

A users group approach to quality improvement across an integrated healthcare delivery system

Aurora Healthcare, an integrated healthcare delivery system, wanted to use interhospital collaboration to improve quality. An opportunity for improvement at five Aurora hospitals was identified: Only 71% of patients received timely preoperative antibiotic prophylaxis. A Users Group approach was proposed to foster collaboration among the hospitals in a quality improvement (QI) effort. Although these hospitals differed in size, volume of cases, medical staffs, and antibiotic-delivery processes, they had common objectives and, many times, common barriers to the timely delivery of antibiotics. A Users Group approach to this QI initiative resulted in an 18% improvement in the number of patients who received timely administration of preoperative antibiotic prophylaxis (p < 0.001). This article describes the Users Group approach to QI at Aurora Healthcare in southeastern Wisconsin.

California's approach to perinatal substance abuse: toward a model of comprehensive care

In the late 1980s and early 1990s there was a growing awareness of the many health, social, psychological, treatment, and recovery needs of pregnant and parenting women and their drug-exposed children. This awareness sensitized policymakers and service providers to the necessity for women-centered programs. Many points of intervention, from primary prevention to treatment of drug dependence, are required to adequately respond to the various needs of this heterogeneous population; a comprehensive women-centered model of care is required that includes health, social, and personal support services. In addition, programs are needed that are aimed at the prevention and treatment of use, abuse, and addiction to alcohol and tobacco, which are dangerous to women's health and birth outcomes and responsible for more costs to society than are associated with use of illicit drugs. The existing system of social services and health care has been fragmented and uncoordinated in responding to substance-abusing women generally, and especially to those who are pregnant and/or parenting. A panel of experts and policymakers in California delineated the appropriate components of a model of service delivery for pregnant and parenting women. This article assesses the implementation of California programs that were informed by the model.