Continuous Adoption of Best Practices: The New Normal

By Rich Umbdenstock
March 23, 2012 | Commentary

The health care field is filled with committed and passionate professionals from all disciplines delivering and improving patient care every day in our country. And over the last several years, the volume of innovation and the creation of new best practices have been occurring at a rapid pace. This includes new checklists, new care bundles, new technologies, and new and redesigned processes of care and service. The result is countless stories of improved outcomes from every type of health care delivery organization and from every part of the country. The opportunity now in front of us is to identify and implement the most effective ways to spread improvement so that we can continuously adopt best practices.

Adopting best practices doesn’t mean taking another’s practices and implementing them “as-is” for yourself. We know that effectively spreading this knowledge requires a plan. We need to have measures. We need to have resources. We need to have tools. We need assistance. And we need to have it personalized to our needs. By learning how to spread improvement, we will exponentially increase the ability of health care organizations and individuals to continuously adopt best practices. Learning how to effectively implement best practices from one to another will have a compounding, positive impact on patient outcomes.

The American Hospital Association (AHA) is working to accelerate the efforts of hospitals and health systems to transform care delivery to meet the nation’s aims for care that is safe, timely, effective, efficient, equitable, and patient-centered. Hospitals in Pursuit of Excellence (HPOE) is the AHA’s strategic platform to accelerate performance improvement and delivery system transformation. HPOE provides education on best practices through multiple channels, develops evidence-based tools and guides, provides leadership development through fellowships and networks, and engages hospitals in national improvement projects.

For example, national improvement projects led by the AHA’s Health Research & Educational Trust (HRET) provide opportunities to replicate processes that work in one area in many areas—that is, to learn, to copy, to adopt, and to spread. With support from the Agency for Health care Research and Quality, HRET is partnering with state hospital associations, the Johns Hopkins Quality and Safety Research Group, and the Keystone Center for Patient Safety and Quality of the Michigan Health & Hospital Association to reduce the rate of central line-associated bloodstream infections (CLABSI). To date, this project has the participation of 46 hospital associations, which have collectively recruited more than 1,000 hospitals and 1,750 hospital teams to participate in the project. And the impact on outcomes is significant: a relative rate reduction of CLABSI infections per 1,000 central-line days of 33 percent, with nearly 70 percent of units reporting a rate of 0 percent. This translates to millions of dollars saved, several hundred infections avoided, and many deaths prevented.

This spread of improvement—this acceleration of learning—is not a random event. With resources, a proven intervention, a customizable technical assistance plan, and measurable objectives, spread of this magnitude and speed will become widespread. A learning, transforming health care system necessitates our focus on spreading improvement by learning from each other.

As young students, we were told not to talk to others or copy from others, but to do the work ourselves. We now need to communicate, emulate, and disseminate from others to accelerate improvement. The new normal is to learn from each other and continuously adopt best practices so that we can deliver the best patient care across the entire health care system.

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Suggested Citation

Umbdenstock, R. 2012. Continuous Adoption of Best Practices: The New Normal. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC.

Author Information

Rich Umbdenstock is President and CEO of the American Hospital Association.


Authored commentaries in this IOM Series draw on the experience and expertise of field leaders to highlight health and health care innovations they feel have the potential, if engaged at scale, to foster transformative progress toward the continuously improving and learning health system envisioned by the IOM. Statements are personal, and are not those of the IOM or the National Academies.

In this commentary, Rich Umbdenstock’s discussion of “best practices” as the starting point for care touches on several issues and lessons central to the delivery of care that is effective, efficient, and continuously improving,

  • The establishment and use of best practices as the baseline for each care experience.
  • Approaches to gathering, assessing, and constantly improving best-practice protocols across institutions.
  • Use of best practices to establish and assess practice standards.
  • System-wide efforts to educate health care professionals and organizations on availability and use of established best practices.

Information on the IOM’s Learning Health System work may be found at


The views expressed in this commentary are those of the author and not necessarily of the author’s organization or of the Institute of Medicine. The commentary is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council.

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