Healthcare Quality Improvement Research Articles

STATISTICAL METHODS TO IMPROVE THE QUALITY ASSESSMENT OF CLINICAL AUDIT RESULTS

The research aims at improving the quality assessment of clinical audit results in Ukraine using the complex of statistical methods and studying statistical methods in foreign reports of the clinical audit and personal experience.
 Materials and Methods. The research was performed by analyzing the reports of clinical audit (n=62), held during 2021 by the Healthcare Quality Improvement Partnership. The spectrum of statistical methods was extended by the analysis of the example of a sociological survey of patients (n=405) regarding the quality assessment of medical care. The methods applied in the current study included systemic approach and analysis, structural and logical analysis, correlation and regressive analysis, calculation of relative values.
 Results and Discussion. All 100% clinical audit reports, carried out by the Healthcare Quality Improvement Partnership were based on the results of the statistical calculations. The most common method of processing results is the epidemiological statistics (93.5%), ratio of chances/risks (30.6%), probability assessment by Х2 Pearson's method (21.0%). It is noteworthy that for pointing the central tendency almost in half of the cases (46.8 %) the median and the Interquartile Range were used. Complex mathematical methods such as the survival assessment by Kaplan- Meier and method multiple regression were used in 6.5 % та 4.8 % reports, accordingly.
 Conclusions. Based on our own experience, we suggested implementation of standardization methods, a detailed correlation and regressive analysis, neuro networks and power analysis into the methodology (technique) of the clinical audit. Implementation of spectrum of evidentially substantiated methods of statistical analysis will allow to increase the evidence level and to deepen the statistical analysis of databases when conducting the clinical audit, аnd therefore, the quality assessment of clinical audit results will increase.

A Brief Review of Healthcare System Transformation Directions

The health care systems globally are undergoing constant changes and redesign processes within the framework of increasing patient expectations and increasingly challenging objectives related to the health of populations, cost reduction and improvement of health care quality. New approaches of healthcare reimbursement and payment are being implemented with the aim to contain costs. In parallel, there are relentless efforts to improve the quality of care through the reorganization of the healthcare team, increasingly relying on evidence, putting the patients at the centre of care, and greater participation of the patients in the process of healthcare. Overcoming the fragmentation of health systems is a major challenge for most countries of the world. In this light, healthcare system innovation and transformation, in order to meet the expectations of the patients, healthcare professionals and other stakeholders involved is of critical importance. System thinking offers an opportunity for healthcare professionals and experts of health system administration, management and strategic planning to fine-tune the health system so that it can fulfil its aspirations.

Routine Practice Data for Health Care Analyses: Part 3 of the Manual

Analyses of health and health care (hereafter referred to as "health care analyses") usually aim to make transparent the structures, processes, results and interrelationships of health care and to record the degree to which health care systems and their actors have achieved their goals. Health care-related data are an indispensable source of data for many health care analyses. A prerequisite for the examination of a degree of goal achievement is first of all an agreement on those goals that are to be achieved by the system and its substructures, as well as the identification of the determinants of the achievement of the objectives. Primarily it must be examined how safely, effectively and patient-centred systems, facilities and service providers are operating. It also addresses issues of need, accessibility, utilisation, timeliness, appropriateness, patient safety, coordination, continuity, and health economic efficiency and equity of health care. The results of health care include system services (outputs), on the one hand, and results (outcomes), on the other, whereby the results (patient-reported outcomes) and experiences (patient-reported experiences) reported are of particular importance. Health care analyses answer basic questions of health care research: who does what, when, how, why and with which resources and effects in routine health care. Health care analyses thus provide the necessary findings and key figures to further develop health care in order to improve the quality of health care. The applications range from capacity analyses to following innovations up to the concept of regional and supra-regional monitoring of the quality of care given to the population. Given the progress of digitalisation in Health Care, direct data from the care processes will be increasingly available for health care research. This can support care givers significantly if the findings of the studies are applied precisely and correctly within an adequate methodological frame. This can lead to measurable improved health care quality for patients. Data from the process of health care provision have a high potential. Their use needs the same scientific scrutiny as in all other scientific studies.

Software development process of Neotree - a data capture and decision support system to improve newborn healthcare in low-resource settings.

The global priority of improving neonatal survival could be tackled through the universal implementation of cost-effective maternal and newborn health interventions. Despite 90% of neonatal deaths occurring in low-resource settings, very few evidence-based digital health interventions exist to assist healthcare professionals in clinical decision-making in these settings. To bridge this gap, Neotree was co-developed through an iterative, user-centered design approach in collaboration with healthcare professionals in the UK, Bangladesh, Malawi, and Zimbabwe. It addresses a broad range of neonatal clinical diagnoses and healthcare indicators as opposed to being limited to specific conditions and follows national and international guidelines for newborn care. This digital health intervention includes a mobile application (app) which is designed to be used by healthcare professionals at the bedside. The app enables real-time data capture and provides education in newborn care and clinical decision support via integrated clinical management algorithms. Comprehensive routine patient data are prospectively collected regarding each newborn, as well as maternal data and blood test results, which are used to inform clinical decision making at the bedside. Data dashboards provide healthcare professionals and hospital management a near real-time overview of patient statistics that can be used for healthcare quality improvement purposes. To enable this workflow, the Neotree web editor allows fine-grained customization of the mobile app. The data pipeline manages data flow from the app to secure databases and then to the dashboard. Implemented in three hospitals in two countries so far, Neotree has captured routine data and supported the care of over 21,000 babies and has been used by over 450 healthcare professionals. All code and documentation are open source, allowing adoption and adaptation by clinicians, researchers, and developers.

Professional values and job satisfaction neonatal intensive care unit nurses and influencing factors: A descriptive correlational study

BackgroundSince the neonatal intensive care unit (NICU) is a vital ward in the hospital, evaluating NICU nurses' satisfaction and professional values is vital for improving health care quality. This study aimed to investigate professional values and nurses' job satisfaction in NICU nurses and influencing factors. MethodsThis analytical cross-sectional study was conducted on 316 NICU nurses in NICUs of nine hospitals in Fars province, Iran, from October 2018 to May 2019. The subjects were selected by the census method. Herzberg's Job Satisfaction Questionnaire and Nurses Professional Values Scale-Revised were used for data collection. Data were analyzed by SPSS version-24. ResultsResults showed a significant correlation between the total score of professional values and job satisfaction and also with its subscales (i.e., motivational and hygiene factors) (P < 0.001). However, age, marital status, education level, and working position were predictors of professional values, and type of hospital, insurance, and income were predictors of job satisfaction (P < 0.001). In motivational factors, job satisfaction was related to nursing values such as trust, caring, activism, professionalism, and justice (P < 0.001). ConclusionGenerally, job satisfaction was significantly correlated with nursing professional values in all subscales, especially trust. Furthermore, being single and working in a private hospital was associated with higher professional values and job satisfaction. Therefore, managers should provide better facilities and work conditions for their personnel. In addition, they are recommended to create a sense of trust between nurses and their coworkers.

The development of the concept of return-on-investment from large-scale quality improvement programmes in healthcare: an integrative systematic literature review

BackgroundReturn on Investment (ROI) is increasingly being used to evaluate financial benefits from healthcare Quality Improvement (QI). ROI is traditionally used to evaluate investment performance in the commercial field. Little is known about ROI in healthcare. The aim of this systematic review was to analyse and develop ROI as a concept and develop a ROI conceptual framework for large-scale healthcare QI programmes.MethodsWe searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar using ROI or returns-on-investment concepts (e.g., cost–benefit, cost-effectiveness, value). We combined this terms with healthcare and QI. Included articles discussed at least three organisational QI benefits, including financial or patient benefits. We synthesised the different ways in which ROI or return-on-investment concepts were used and discussed by the QI literature; first the economically focused, then the non-economically focused QI literature. We then integrated these literatures to summarise their combined views.ResultsWe retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. The included articles were QI economic, effectiveness, process, and impact evaluations as well as reports and conceptual literature. Fifteen of 68 articles were directly focused on QI programme economic outcomes. Of these, only four focused on ROI. ROI related concepts in this group included cost-effectiveness, cost–benefit, ROI, cost-saving, cost-reduction, and cost-avoidance. The remaining articles mainly mentioned efficiency, productivity, value, or benefits. Financial outcomes were not the main goal of QI programmes. We found that the ROI concept in healthcare QI aligned with the concepts of value and benefit, both monetary and non-monetary.ConclusionOur analysis of the reviewed literature indicates that ROI in QI is conceptualised as value or benefit as demonstrated through a combination of significant outcomes for one or more stakeholders in healthcare organisations. As such, organisations at different developmental stages can deduce benefits that are relevant and legitimate as per their contextual needs.Trial registrationReview registration: PROSPERO; CRD42021236948.

Infection Control in Intensive Care Units

Infections acquired in the hospitals, especially in the intensive care unit (ICU) settings, ranging between 15% and 20%, may further lead to complications in >40% in critically ill patients. The order of incidence may vary in different settings, but the most usual causes are ventilator-associated pneumonia, intravascular catheter-associated bloodstream infection, catheter-associated urinary tract infection, posttraumatic intra-abdominal infection, and surgical site infection. These can be prevented by adequate and appropriate application of preventive strategies, which can be implemented strictly at the bedside. The basic norms for surveillance strategies, general preventive measures such as standard and isolation precautions and monitoring of antibiotic use should be followed without fail. Specific practical measures for ICU-related infections should be in place, and the monitoring of activities should be documented regularly as “bundle-care” in view of standardizing the practice, irrespective of place or person. Adequate attention, unfortunately, has not been paid for infection control measures in India for years. It is now mandatory that the essential practices are prioritized and integrated fully into regular hospital administrative procedure as a continuous process for improving quality health care.

The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa

ObjectiveChampions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human...

Pain in Austrian hospitals: evaluation of 1089 in-patients.

Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures, e.g., acute pain services, various studies have shown that pain is still common among both surgical and non-surgical in-patients. The primary objective of this study was to evaluate, on amulti-center basis, the point pain prevalence of surgical and non-surgical in-patients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality. We surveyed all adult in-patients in three general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on the index day with two standardized questionnaires for both surgical and non-surgical patients. Overall, apain prevalence of 40.0%, with no statistically significant difference between surgical and non-surgical patients, was shown. Higher pain prevalence in female patients, high pain prevalence in the age group 18-30years, and highest pain prevalence in the age group over 90years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization were found. Our survey has shown that pain has an impact on personal hygiene, mobilization, mood, sleep, and appetite. However, patients were very satisfied with their pain therapy. Medical staff and nurses have to be sensitized to the urgent need to improve pain management strategies.

Health care quality improvement fluency: The secret sauce to improving quality improvement

The goal of quality improvement (QI) in healthcare is to improve patient outcomes. An easily supported, simple, and desirable objective. Fortunately, over the past 20 years, healthcare has “embraced” quality improvement, but that journey is remarkably incomplete. QI has infiltrated mainstream thinking for many clinicians and healthcare administrators; however, using the words and speaking the QI language does not always translate to the effective execution of improvement processes that lead to better outcomes.

Using Rapid Randomized Trials to Improve Health Care Systems.

Rapid randomized controlled trials have been surprisingly rare in health care quality improvement (QI) and systems interventions. Applying clinical trials methodology QI work brings two distinct fields together, applying the robustness of randomized controlled trials (RCTs) to the practical, operational learnings of the well-established QI field. Rapid trials also add a third element-speed-that enables health care systems to rapidly test multiple variations of an intervention in much the same way that A/B testing is done in the technology sector. When performed well, these rapid trials free researchers and health care systems from the requirement to be correct the first time (because it is low cost and quick to try something else) while offering a standard of evidence often absent in QI. Here we outline the historical underpinnings of this approach, provide guidance about how best to implement it, and describe lessons learned from running more than 20 randomized projects in the NYU Langone Health system.

Abstract 12799: Improving Healthcare Quality Through Innovative Training in Implementation Science

Introduction: Despite the rapid accumulation of evidence, translating this evidence into clinical practice is slow and inefficient. A key barrier is limited understanding of implementation science (IS). As part of a regional strategy to improve the value of healthcare, the Healthcare Institute for Innovations in Quality (HI-IQ) built a curriculum and certificate program, Training in Implementation: Actionable Research Approaches (TIARA) to train researchers and providers with skills in IS. Methods: HI-IQ has built a multi-stakeholder consortium, conducted a healthcare needs assessment, and begun regional QI implementation across multiple hospitals. To support regional QI, TIARA 1.0 was developed and launched as a Certificate program from the Frontiers Clinical &amp; Translational Science Institute (CTSI), with online recordings (www.kcqvic.org/trainings/). Results: Participants (n=120) in TIARA 1.0 came from hospitals, payers, health departments, community-based organizations, and academic institutions. Over 60% of participants reported increases in IS expertise after training. Across all IS competencies (n=8), participants increased an average of 3.7 points (Figure 1). These skills are being applied in a regional program to improving transitions in care for heart failure to not only evaluate the outcomes, but also the facilitators and barriers to implementing the evidence. Due to demand for more and expanded training opportunities in IS, both coursework and additional professional training are being developed. Conclusions : There is a significant unmet need to expand skills in IS for those working in real-world quality improvement and clinical care. HI-IQ’s training approach, utilizing online-hybrid delivery, applied content for practitioners, and real-world project-based applications are promising strategies to train practitioners in how to change healthcare and can model a strategy for other regions to consider in improving care.

The Convergence of Customer Orientation and Collaborative Health Care Leadership in Lithuania

Improving health care quality is a continuous goal that requires constant attention and innovative solutions. One of the sources from which we can learn about what quality changes are needed is patient experience. "Collaboration" is one way to develop instruments and use them to gather knowledge about patient needs related to the patient journey and measures to improve the quality of services, such as service collaboration. The direction, in terms of the identification of patient needs and relatively urgent changes to the system, depends on the organizational culture determined by leadership. Different approaches towards leadership initiate different outcomes and consequences. Collaborative health care leadership comes with the decision to strengthen collaboration between health professionals and patients, thus addressing service quality gaps. Therefore, it becomes important to understand patients’ expectations in terms of such cooperation.&#x0D; The study aim is to investigate whether patient satisfaction barriers can be linked to shortages in collective leadership.&#x0D; All three dimensions of collaborative leadership (horizontal collaboration, interorganizational (vertical) collaboration, and collaboration with patients) demonstrate the link between leadership and accepted health care quality.

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Drug provision is one of the health care key problems in many countries, including Armenia. The World Health Organization is implementing a policy aimed at introducing the principles of effective use of drugs in countries, offering to introduce and improve formulary systems as a tool for effective use of drugs. The formulary system is currently used in all developed countries and provides many advantages, the most important of which is the improvement of health care quality. Formulary list of drugs include only those drugs that are proven effective, safe, high quality and cost-effective, facilitating the work of the prescribers, decreasing medical errors and the complications of pharmacotherapy, thus improving public health indicators. Thus, the formulary system is an effective mechanism, that allows using drugs effectively, reduces the costs of their acquisition and, consequently, improves drugs provision to the population. Therefore, its introduction in health facilities of Armenia will be one of the most effective steps to have positive changes in the health care system.

Network evaluation of an innovation platform in continuous quality improvement in Australian Indigenous primary healthcare

BackgroundFrom 2014 to 2019, the Centre for Research Excellence in Integrated Quality Improvement (CRE-IQI) was evaluated as an innovation platform focusing on continuous quality improvement in Indigenous Australian primary healthcare. Although social network analysis (SNA) is a recognized method for evaluating the functioning, collaboration and effectiveness of innovation platforms, applied research is limited. This study applies SNA to evaluate the CRE-IQI’s functioning as an innovation platform.MethodsTwo surveys (2017, 2019) were conducted using social survey and network methods. Survey items covered respondent characteristics, their perceptions of the CRE-IQI’s performance, and its impact and sociometric relationships. Members’ relationship information was captured for the CRE-IQI at three time points, namely start (retrospectively), midpoint and final year, on three network types (knew, shared information, collaborated). SNA software was used to compute standard network metrics including diameter, density and centrality, and to develop visualizations. Survey and network results were addressed in a workshop held by members to develop improvement strategies.ResultsThe response rate was 80% in 2017 and 65% in 2019 (n = 49 and 47, respectively). Between 2017 and 2019, respondents’ mean ratings of the CRE-IQI’s functioning and achievements in meeting its goals were sustained. They perceived the CRE-IQI as multidisciplinary, having effective management and governance, and incorporating Indigenous research leadership, representation and ways of working. Respondents recognized high levels of trust amongst members, rated “good communication and coordination with participants” highly, and “facilitating collaboration” as the CRE’s most strongly recognized achievement. In collaboration and information-sharing networks, average path length remained low in 2017 and 2019, indicating good small-world network properties for relaying information. On average, respondents shared information and collaborated with more CRE members in 2017 than 2019. However, in both 2017 and 2019 there were new collaborations and information-sharing outside of direct collaborations. CRE-IQI outcomes included: evidence generation; knowledge transfer and skills development in quality improvement; research capacity-building, career development; mentoring; grant support; development of new projects; health service support; and policy impact.ConclusionsThis study shows the utility of network analysis in evaluating the functioning, and collaboration, at the individual, organizational and health system levels, of an innovation platform, and adds to our understanding of factors enabling successful innovation platforms.

A Novel Technique for Data Quality Improvement in Human Health PHM

Human healthcare data cover different signals related to the functioning of the human body such as blood pressure, blood glucose, heart rate, among others. This kind of data plays an important role on ill patients in the intensive care unit. Unfortunately, the recorded data may include connection &amp; human errors, measurement errors due to the movement of patients, among others. These errors are better known as Artifacts and they should be removed in case the data needs to be used for clinical purposes. Different methods have been proposed for artifact detection; however, the existing methods only analyze one signal at a time or rely on feature engineering. In this study, we present an alternative solution for artifact detection that integrates signals such as Intracranial Pressure (ICP), Electrocardiogram (ECG), and Arterial Blood Pressure (ABP). Time raw domain data, Fourier transform, and the combination of both were studied as the input of neural network models. Four deep learning algorithms were employed: convolutional neural network (CNN), long short-term memory (LSTM), bidirectional LSTM (BiLSTM), and transformer neural network. By performing a cross-validation ensemble using a dataset of 39 patients with noisy signals, the Fourier transform and CNN (FT-CNN) model outperformed the other deep learning models in terms of accuracy and computational time. This study shows that deep learning, Fourier transform, and cross-validation ensemble combined have a great potential in data quality improvement in healthcare.

Trends in mortality associated with surgical site infections: a cohort study in Italy, 2009-2019

Abstract Background Surveillance programs have proven to be effective in reducing surgical site infection (SSI) rates. In 2008 Piedmont joined the Italian national surveillance system. The aim of this study was to evaluate mortality rates and trends associated with SSIs in Piedmont from 2009 to 2019 for the two most frequently performed surgical procedures, hip arthroplasty (HPRO) and colon surgery (COLO). Methods Data were collected through the national surveillance system, which includes 42 hospitals in Piedmont who participated in the surveillance program from 2009 to 2019. Procedure-specific SSI rates, overall mortality rates and case fatality rates (CFR) associated with SSIs were calculated, overall and per year. Trends were evaluated using the chi-squared test for trends. Analyses were performed using Epi Info v. 7.2. Results A total of 33438 surgical procedures (21645 HPRO, 11793 COLO) were monitored over the study period from the hospitals participating in the network. 1215 SSIs (293 HPRO, 922 COLO) were observed and 617 deaths were registered (222 HPRO, 395 COLO). For HPRO procedures, an overall SSI rate of 1.35% was found, with an overall mortality of 1.03% and a CFR of 3.75%. No significant trend was observed. Considering COLO interventions, an overall SSI rate of 7.82% was found, with an overall mortality of 3.35% and a CFR of 6.94%. There was a statistically significant downward trend in SSI and overall mortality rates (p = 0.046 and 0.005, respectively). Conclusions Considering HPRO, it is possible that the lack of significant trends could be due to the already low SSI and overall mortality rates, with the protective effect of surveillance having reached a plateau. Regarding COLO procedures, a significant reduction in SSI and overall mortality rates was observed during the study period. The reduction in mortality could be due to the decrease in SSI rates, however other factors not analysed in our study could have contributed. Key messages • This study brings further evidence to the protective effect of surveillance, attributable to an improvement in healthcare quality and patients’ safety. • A significant decrease in COLO mortality rates was observed, which could be due to the decreasing trend in SSI rates.

An integrated care pathway for maternal and childcare: evidence from Ethiopia, Tanzania, and Uganda

Abstract Performance monitoring and evaluation are key to quality improvement in maternal and child healthcare in Sub-Saharan Africa. This study presents the experience of designing and implementing bottom-up and integrated performance evaluation tools for care pathway to monitor and manage maternity healthcare services. The research project involved four health districts and relative reference hospitals, supported by the NGO Doctors with Africa CUAMM in Ethiopia, Tanzania, and Uganda. The maternal and childcare pathway developed consists of 23 indicators, calculated at hospital and district level, relating to pregnancy, childbirth and first year of life phases. The authors developed staves and performance maps, as graphical representation tools, to display longitudinally integrated health services provision performance along the continuum of care. Substantial variation was observed between the phases of each maternal and childcare pathway and across the care pathways of the different analysed settings. The most impressive results across the four settings are: 1) regarding pregnancy phase, that women tend to attend more than four antenatal classes, still with a quite high drop-out rate, and are largely tested for syphilis, 2) with respect to childbirth, that there are varying percentage levels in terms of C-sections, episiotomies and peri/intra-partum asphyxia cases, and 3) as it regards first year of life, there emerges scope for improvement considering the vaccination coverages attained for pentavalent, measles and polio vaccinations. Thanks to the collaboration with local managers and health professionals, the maternal and childcare pathway allowed to monitor the changes in the quality of maternity services provided within the analysed contexts. The benchmarking approach encouraged local professionals to learn from other settings. The use of such tool allowed the development of targeted quality improvement actions, shared among all involved stakeholders. Key messages • In collaboration with local professionals, we designed and implemented an integrated pathway for maternal and childcare, covering the phases of pregnancy, childbirth and first year of life. • Benchmarking performance results encouraged collaboration among professionals and allowed the identification of actions to improve the provision of maternal and childcare services.

Distinct components of alert fatigue in physicians' responses to a noninterruptive clinical decision support alert.

Clinical decision support (CDS) alerts may improve health care quality but "alert fatigue" can reduce provider responsiveness. We analyzed how the introduction of competing alerts affected provider adherence to a single depression screening alert. We analyzed the audit data from all occurrences of a CDS alert at a large academic health system. For patients who screen positive for depression during ambulatory visits, a noninterruptive alert was presented, offering a number of relevant documentation actions. Alert adherence was defined as the selection of any option offered within the alert. We assessed the effect of competing clinical guidance alerts presented during the same encounter and the total of all CDS alerts that the same provider had seen in the prior 90 days, on the probability of depression screen alert adherence, adjusting for physician and patient characteristics. The depression alert fired during 55649 office visits involving 418 physicians and 40474 patients over 41 months. After adjustment, physicians who had seen the most alerts in the prior 90 days were much less likely to respond (adjusted OR highest-lowest quartile, 0.38; 95% CI 0.35-0.42; P < .001). Competing alerts in the same visit further reduced the likelihood of adherence only among physicians in the middle two quartiles of alert exposure in the prior 90 days. Adherence to a noninterruptive depression alert was strongly associated with the provider's cumulative alert exposure over the past quarter. Health systems should monitor providers' recent alert exposure as a measure of alert fatigue.

Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery.

This study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems. Originally developed in manufacturing, Lean is an evidence-based approach to quality and process improvement in healthcare. Although Lean has been studied in individual hospital units and outpatient practices, it has not been examined as a whole system response to crisis events. We conducted qualitative interviews with 46 executive leaders, clinical leaders, and frontline staff in four hospitals and health systems across the United States. We developed a semistructured interview guide to understand DMS implementation in these care delivery organizations. As interviews took place 6-8 months following the onset of the pandemic, a subset of our interview questions centered on DMS use to meet the demands of COVID-19. Based on a deductive approach to qualitative analysis, we identified clusters of themes that described how DMS facilitated rapid system response to the public health emergency. There were many important ways in which U.S. hospitals and health systems leveraged their DMS to address COVID-19 challenges. These included the use of tiered huddles to facilitate rapid communication, the creation of standard work for redeployed staff, and structured problem-solving to prioritize new areas for improvement. We also discovered ways that the pandemic itself affected DMS implementation in all organizations. COVID-19 universally created greater DMS visibility by opening lines of communication among leadership, strengthening measurement and accountability, and empowering staff to develop solutions at the front lines. Many lessons learned using DMS for crisis management will carry forward into COVID-19 recovery efforts. Lessons include expanding telehealth, reactivating incident command systems as needed, and efficiently coordinating resources amid potential future shortages. Overall, the Lean DMS functioned as a robust property that enabled quick organizational response to unpredictable events. Our findings on the use of DMS are consistent with organizational resilience that emphasizes collective sense-making and awareness of incident status, team decision-making, and frequent interaction and coordination. These features of resilience are supported by DMS practices such as tiered huddles for rapid information dissemination and alignment across organizational hierarchies. When used in conjunction with plan-do-study-act methodology, huddles provide teams with enhanced feedback that strengthens their ability to make changes as needed. Moreover, gaps between work-as-imagined (how work should be done) and work-as-done (how work is actually done) may be exacerbated in the initial chaos of emergency events but can be minimized through the development of standard work protocols. As a facilitator of resilience, the Lean DMS may be used in a variety of challenging situations to ensure high standards of care.