Over the last several years, healthcare quality has come under increased scrutiny. In 2001, the Institute of Medicine's report, Crossing the Quality Chasm, highlighted the lack of consistency in the quality of care in the American healthcare system. The IOM report showed that the causes of these variations in quality include the increasingly complex nature of healthcare delivery, increases in chronic conditions, and advances in science, medical technology, and information technology.
Many hospitals and healthcare systems reacted by attempting to improve the quality of care they delivered to their patients. Today, with healthcare reform and accountable care organizations, the industry continues to emphasize quality. One way that healthcare systems address quality improvement is by adding quality goals to executive incentive plans.
Quality Initiatives
After the IOM study, many organizations reacted with further studies of healthcare quality and quality improvement initiatives. These initiatives sought to measure performance as a tool to assess healthcare quality.
Many healthcare organizations used the quality measures in these studies as a method to assess quality and measure performance. In a recent survey on quality measures used at hospitals and healthcare systems, we found that the CMS Hospital Quality Initiative measures were the most common. When this survey was conducted, more than half of the respondents used the CMS measures to assess quality.
CMS measures have become popular because CMS collected ample data for comparative purposes, its measurements are standardized across the industry, the validity of the data is generally accepted in the industry, and healthcare organizations have a strong financial incentive to report their results, which CMS makes available to the public.
While the CMS HQI measures are popular, they are not the only measures used to assess healthcare quality. The survey also found that 9% used standards developed by state or local regulatory bodies and 23% used some other internally developed measure.
Types of Quality Measures
Quality measures are used to gauge how well care is provided to patients. Almost all quality measures used in the healthcare industry are categorized as one of three types: Outcome, Process, and Structure.
Outcome measures evaluate the results of the contact between a patient and the healthcare system. The percentage of patients who develop community-acquired pneumonia is an example of an outcome measure.
Process measures assess standards of care, where 100% performance is the target. The administration of an antibiotic one hour prior to surgery is an example of a process measure.
Structure measures gauge the creation or operation of a particular feature of the organization that helps provide quality healthcare. The creation of a new computer system that measures quality is an example of a structure measure.
Internally Developed Quality Measures
Some healthcare organizations have developed their own quality measures. These quality measures often respond to a specific problem or a perceived shortcoming in care at that organization. According to our recent survey, the four most popular internally developed quality measure categories are: Achieving specific clinical outcomes, reducing medication errors, implementing internally developed treatment standards, and reducing patient falls.
Setting Quality Goals
Quality goals are often a part of executive incentive plans. This strategy is a good way to reinforce an organization's goals and clarify executive expectations. To be effective, quality goals should be selected that best meet the following characteristics:
- Understandable
- Baseline performance well-established
- External benchmark data available
- Reflective of performance throughout the performance cycle
Most healthcare organizations set quality goals based more on incremental improvement in a performance cycle rather than on achieving large, highly ambitious leaps in quality. Goals are typically set at a certain level above the baseline from the previous performance cycle. These goals can either compare the organization's quality performance with performance from past years, or compare performance with an industry standard.
With the increased quality requirements that will be enforced on hospitals and health systems in our new healthcare environment, the measurement, assessment, and use of performance-enhancing initiatives against quality standards will only become more necessary.
Eric Reehl is a senior consultant with the executive compensation and governance practice of Integrated Healthcare Strategies.