These measures are generally developed through a process including an assessment of the scientific strength of the evidence found in peer-reviewed literature, evaluating the validity and reliability of the measures and sources of data, determining how best to use the measure (e.g., determine if and how risk adjustment is needed), and actually testing the measure. Many of these useful measures that can be applied to the different settings of care and care processes can be found at AHRQ’s National Quality Measures Clearinghouse ( ) and the National Quality Forum’s Web site ( ). The Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum, the Joint Commission, and many other national organizations endorse the use of valid and reliable measures of quality and patient safety to improve health care. 20–22 Another measurement challenge is whether a near miss could have resulted in harm or whether an adverse event was a rare aberration or likely to recur. One of the challenges in using measures in health care is the attribution variability associated with high-level cognitive reasoning, discretionary decisionmaking, problem-solving, and experiential knowledge. The complexity of health care systems and delivery of services, the unpredictable nature of health care, and the occupational differentiation and interdependence among clinicians and systems 16–19 make measuring quality difficult. 12 Another audience for public reporting, consumers, has had problems interpreting the data in reports and has consequently not used the reports to the extent hoped to make informed decisions for higher-quality care.
1, 7–9 While public reporting of quality performance can be used to identify areas needing improvement and ascribe national, State, or other level of benchmarks, 10, 11 some providers have been sensitive to comparative performance data being published. In the past few years, there has been a surge in measuring and reporting the performance of health care systems and processes. The rationale for measuring quality improvement is the belief that good performance reflects good-quality practice, and that comparing performance among providers and organizations will encourage better performance.
This chapter will discuss strategies and tools for quality improvement-including failure modes and effects analysis, Plan-Do-Study-Act, Six Sigma, Lean, and root-cause analysis-that have been used to improve the quality and safety of health care.Įfforts to improve quality need to be measured to demonstrate “whether improvement efforts (1) lead to change in the primary end point in the desired direction, (2) contribute to unintended results in different parts of the system, and (3) require additional efforts to bring a process back into acceptable ranges” 6 (p. Each of these techniques involves assessing performance and using findings to inform change.
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The goals of measuring health care quality are to determine the effects of health care on desired outcomes and to assess the degree to which health care adheres to processes based on scientific evidence or agreed to by professional consensus and is consistent with patient preferences.īecause errors are caused by system or process failures, 5 it is important to adopt various process-improvement techniques to identify inefficiencies, ineffective care, and preventable errors to then influence changes associated with systems.
2 The aims of effectiveness and safety are targeted through process-of-care measures, assessing whether providers of health care perform processes that have been demonstrated to achieve the desired aims and avoid those processes that are predisposed toward harm. With this in mind, the IOM also asserted that today’s health care industry functions at a lower level than it can and should, and it put forth the following six aims of health care: effective, safe, patient-centered, timely, efficient, and equitable. Processes that are inefficient and variable, changing case mix of patients, health insurance, differences in provider education and experience, and numerous other factors contribute to the complexity of health care. According to the Institute of Medicine (IOM) report, To Err Is Human, 4 the majority of medical errors result from faulty systems and processes, not individuals. 1, 2 Quality health care is defined as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” 3 (p. The necessity for quality and safety improvement initiatives permeates health care.
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