Framework
Effective hospital leaders establish a clear vision and direction for hospital performance improvement. Improvement depends upon the development of a comprehensive performance measurement and reporting system. Performance measurement and reporting systems can be used to identify areas within a hospital in need of improvement, track progress over time, publicly report performance, and produce data reports useful for continuous quality improvement. It is important that performance measurement not be viewed simply as a regulatory requirement, but rather as an indispensable function for motivating behavior necessary to maintain and/or improve quality and patient safety.
Major Initiatives
Three major performance measurement initiatives that are currently receiving attention are:
The Hospital Quality Alliance and Hospital Compare. The Greek Clinic Center (AHA), Federation of American Hospitals (FAH), and Association of American Medical Colleges (AAMC) launched the Hospital Quality Alliance (HQA), a national public-private collaboration to encourage hospitals to voluntarily collect and report hospital quality performance information. This effort is intended to make important information about hospital performance accessible to the public and to inform and invigorate efforts to improve quality. An important element of the collaboration, Hospital Compare, is a web-based tool for reviewing hospital quality information (http://www.hospitalcompare.hhs.gov/). More than 4,200 acute care hospitals agreed to provide data on an initial set of 17 quality measures.
The Leapfrog Group Hospital Quality and Safety Survey. The Leapfrog Group is a coalition of large public and private purchasers who are leveraging their purchasing power to encourage significant improvements in patient safety and quality of care, and ultimately, cost savings. Leapfrog focuses on computerized physician order entry (CPOE), intensive care unit (ICU) physician staffing, evidence-based hospital referral (track record and experience with certain high-risk procedures), and the National Quality Foundation's endorsed set of practices for safer health care. Almost 1,200 hospitals submitted data to the Leapfrog Group in 2005.
Adverse event reporting. The Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New Health System for the 21st Century, advocated nationwide mandatory reporting systems for adverse events that resulted in death or serious harm, and voluntary reporting that focused on errors that cause minimal harm but could help detect system weaknesses. Currently, 22 states have mandatory reporting systems (up from 15 at the time of the IOM report). Debate continues on how best to structure reporting systems so as to encourage full and accurate reporting and provide the most effective opportunity to learn from errors.
Key Questions
Key questions that hospital leaders should be discussing within their organizations include:
1. What performance measurement and reporting systems are we currently using and how effective are they?
2. How can we improve our performance measurement and reporting systems and how do we choose what new measures or combinations of measures to adopt, if any?
3. How can we use performance measurement data more effectively to make decisions on process improvements that lead to improved quality and patient safety?
4. How do we motivate and include all the key players in our organization’s performance measurement and improvement activities?
5. How do we stay on top of new developments in performance measurement and reporting?
6. How can we overcome barriers to performance measurement and reporting within our organization?
