Healthcare Quality Measurement

Healthcare Quality Measurement Milestones
There seven key milestones in the quality measurement journey:

Milestone1
The first step is achieved by engaging in serious dialogue within the organization on the role of the performance measurement.

Milestone2
The second milestone consists of deciding which concepts (sometimes called types or categories of measures) the organization wishes to monitor.

Milestone3
Is identifying specific measures.

Milestone4
Development of operational definitions of specific measures begins at milestone4.

Milestone5
Data collection is the billboard for milstone5.

Milestone6
A list of discussion questions that we should consider as we develop an analysis plan.

Milestone7
The final milestone of the measurement journey involves acting with the data and the conclusion about inherent variation in the measure we are tracking.

Measuring and Improving Patient Experience of Care
Quality in healthcare has two dimensions. Technical excellence: the skill and competence of health professionals and the ability of diagnostic and therapeutic equipment, procedures, and systems to accomplish what they are meant to accomplish, reliably and effectively.

The other dimension relates to the subjective experience, and in healthcare, it is quality in this subjective dimension that patient experience most directly in their perception of illness or well-being and in their encounters with healthcare professionals and institutions, i.e., the experience of illness and healthcare through the patient’s eyes. Healthcare organizations’ ability to deliver high quality, patient centered care to their members and patients depends in part on their understanding of basic customer service principles and their ability to integrate these principles into clinical settings.

Healthcare organizations should pay attention to customer service for several reasons:

1. Better service translates into the higher satisfaction of the patient and, subsequently, for the employer who pays most of the bills.
2. A satisfied (and loyal) patient creates value over the course of a lifetime.
3. Existing patients are an invaluable source of information healthcare organizations can use to learn how to improve what they do to reduce waste by eliminating services that are unnecessary or not valued.
4. Poor customer service raises the risk of a negative “grapevine effect”.

Patient satisfaction or patient experience of care surveys are the most common method used to evaluate quality from the patient’s perspective.

Accreditation
In the past, accreditation in its traditional form has, in some areas of healthcare, provided a successful approach to measuring and reporting accountability. Healthcare clearly needs enhanced accountability. This need demands a more robust set of metrics and accountability at multiple levels of the healthcare system. The challenge is whether accreditation can evolve to meet this expanded demand for accountability.

Use of Accreditation in Healthcare
Accreditation is a process by which an entity external to the organization providing goods or services evaluates that organization against a set of predetermined requirements or desirable attributes and publicly attests to the results.

The term Certification often is used to denote a similar process, except that certification more often is used in reference either to the determination of an individual’s (rather that an organization’s) competency or to the government’s determination of an organization’s eligibility to participate in a government program.

The Process and Content of Accreditation
Accreditation is based on the premise that it is possible both to define attributes critical to the quality and safety of a healthcare product or service and to create a method to measure whether a threshold of performance has been achieved. Critical attributes can be defined for both administrative and clinical activities, and they can be based on expert opinion, a consensus of providers or multiple stakeholders, or research studies. Measurement can involve on-site observation, review of policies, review or abstraction of data from administrative or clinical records, surveys, and interviews with provider staff or patients.
Many accreditation programs still rely on only on-site observation and review of reports and policies, but other types of measurement are feasible.

The Future of Accreditation
If accreditation is to remain an important part of ensuring accountability, accreditation will need to evolve in response to market forces and the evolution of the healthcare system. One of the most important challenges to accreditation is the proliferation of new services and products and the types of organizations that provide them.

Accreditation will need to evolve quickly toward a more flexible, multi-entity, performance-based process to serve both the public interest and that of these new activities. Accreditation also will need to address issues related to coordination of services for patients and data sharing between the increasingly fragmented entities involved in healthcare.

Another factor that continues to gain momentum is public demand for information that allows comparison of individual clinicians, clinical groups, hospitals, and health plans regarding clinical quality and cost.

The long-term hope for more effective accreditation and information about quality depends on an enhancement of information technology use in healthcare. The wide availability of broadband, web-enabled data collection eventually may enable accreditation based on real-time measurement of a rich array of clinical structure, process, and outcome performance measures that also can be used for quality monitoring, rather than on retrospective measures or survey-assessed compliance with standards alone.