Checkpoints on our road toward continuous improvement

I’m writing today to give a shout out to the remarkable folks at the NIH Clinical Center who continue to demonstrate their dedication and commitment to achieving the highest standards in patient care and safety, while carrying out cutting edge research protocols in the “House of Hope”. Clinical and research staff have embraced the pursuit of high reliability, and are focused on early recognition of potential problems and providing solutions for continuous improvement. I often refer to the accomplishments of the Clinical Center staff as important milestones, but that suggests an end point or destination. The road to continuous improvement, however, is never ending. Thus, I want to acknowledge some major achievements, which I’ll call checkpoints, that NIH Clinical Center staff has reached on their continuous improvement journey. These accomplishments are numerous and so I’m going to highlight just a few.

The Clinical Center established daily patient safety huddles, which have become the backbone for the hospital’s patient safety efforts. Starting the day talking about patient safety is a great way to keep it uppermost in everyone’s mind. A new framework for clinical quality and patient safety and the Patient Safety, Clinical Practice and Quality Committee were formed to ensure rigorous surveillance for and reporting of patient safety events. Morbidity and Mortality meetings, once held by invitation to small groups only, are now systems-based and open to all Clinical Center staff. Everyone involved in research and patient care at the NIH Clinical Center has an expanded opportunity to feel empowered to contribute to patient safety and continuous improvement.

The hospital seamlessly implemented a new safety tracking system called STARS with no down time between transition from the old to the new system. The system is only as good as the information that is put into it and the entire clinical staff has been 100 percent committed to reporting and tracking safety metrics. All NIH investigators and research staff (including me!) have been retrained to ensure full awareness and compliance with event reporting requirements. All patient and employee safety/quality metrics are now posted online, and an anonymous hotline number has been established and publicized so that any person at the NIH Clinical Center with a safety concern can report it.

NIH has thus far invested approximately $50 million in improving patient safety, a considerable amount of which has gone to much needed infrastructure improvements at the Clinical Center and aseptic manufacturing facilities. All aseptic facilities producing sterile products used in Clinical Center protocols now adhere to USP standards. A new interim intravenous admixture unit was opened in April 2017. Improvements were made to the facilities, equipment, and standard operating procedures of the NCI Surgery Branch Cell Processing Laboratory for immunotherapy efforts. The Clinical Center PET Radiopharmacy was renovated to support all of NIH’s clinical research needs, and two modular manufacturing facilities following Current Good Manufacturing Practices (cGMP) were purchased to support increased demand for cell engineering. The Clinical Center pharmacy has hired 44 people and instituted a new organizational structure to promote increased oversight and quality assurance.

Additional infrastructure improvements are under construction or in advanced stages of planning. These include opening of the new cellular processing facility on the second floor later this year. A new modular facility located on the east terrace of the Clinical Center to support cell processing and a new free standing modular facility to support cell processing devoted to immunotherapy are expected to be operational in late 2018. Renovation of the Clinical Center E-wing is expected to be completed in 2021.

This is just a snapshot of the improvements made at the NIH Clinical Center, but you can learn about others on the NIH Clinical Center Patient Safety and Clinical Quality Continuous Improvement webpage. I’m proud of the accomplishments of the clinical and research staff at the Clinical Center. The leadership teams of NIH and every NIH Institute and Center conducting research at the hospital commend the NIH Clinical Center and their success.

Francis S. Collins, M.D., Ph.D.
Director, National Institutes of Health