Kelly Vana's Nursing Leadership and Management

Public reporting of organizational performance and quality information is being driven by several forces. As more data about quality become available electronically, individuals reporting the data and those wanting to make comparisons among organizations want the data analyzed and the findings reported. This information can be used to determine where there are health care inefficiencies and poor quality of care. Performance reporting is also used to influence clinician and patient utilization behavior. It also moves health care toward a population‐based approach, as opposed to focusing on individual patient care.

The IOM, established in 1970 under the charter of the National Academy of Sciences, provides independent, objective, evidence‐based advice to policymakers, health professionals, the private sector, and the public. In 1996, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care. The Ensuring Quality Cancer Care Report (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.

Other reports released by the IOM on the quality of health care include:

To Err is Human; Building A Safer Health System (1999);

Crossing the Quality Chasm: A New Health System for the Twenty‐first Century (2001);

Strategies for Addressing the Evolving Nursing Crisis (2002);

Patient Safety: Achieving a New Standard for Care (2003);

Keeping Patients Safe: Transforming the Work Environment of Nurses (2003);

Health Professions Education: A Bridge to Quality (2003);

Priority Areas for National Action: Transforming Health Care Quality (2003);

Performance Measurement: Accelerating Improvement (2005);

Preventing Medication Errors (2006); and

The Future of Nursing: Leading Change, Advancing Health (2010).

A complete listing of IOM Reports is available at www.iom.edu/Reports.aspx

Eight principles are integral to health care reform, as envisioned by the IOM (2008). These eight principles are:

Accountability

Efficiency

Objectivity

Scientific rigor

Consistency

Feasibility

Responsiveness

Transparency

These principles are consistent with a professional nursing agenda, which states that all persons are entitled to affordable, quality health care services (American Nurses Association (ANA), 2010). The Quality Chasm report described broader quality issues, defined six aims, and highlighted ten rules for care delivery redesign ( Table 2.7) (IOM, 2001).

Several key national public quality sources of interest for health care and nursing leaders and managers for purposes of performance measurement and benchmarking or comparison are as follows:

AHRQ National Healthcare Quality Report 2009 Available at www.ahrq.gov/qual/nhqr09/nhqr09.htm

AHRQ National Healthcare Disparities Report 2009 Available at www.ahrq.gov/qual/qrdr09.htm

Healthy People 2010: Available at www.healthypeople.gov

Health Grades for Hospitals and Physicians: Available at healthgrades.com

Leapfrog: Available at www.leapfroggroup.org

The National Quality Forum: Available at www.qualityforum.org

Health Plan and Employer Data and Information Set (HEDIS) & Quality Measurement, National Committee for Quality Assurance (NCQA): Available at www.ncqa.org

Consumer Assessment of Healthcare Providers and Systems (CAHPS), Agency for Healthcare Research and Quality (AHRQ): Available at www.cahps.ahrq.gov/default.asp

Medicare Hospital Compare: Available at www.hospitalcompare.hhs.gov.

The Thomson Reuters 100 Top Hospitals ®: Available at www.100tophospitals.com/top-national-hospitals

U.S. News and World Report Best Hospitals, annual ranking: Available at http://health.usnews.com/best-hospitals

Public reporting of quality performance has been shown to improve care. While providers and policymakers do seek out these public quality reports, the general public does not search them out, does not understand them, distrusts them, and fails to make use of them (Marshall, Hiscock, & Sibbald, 2002). In many respects, hospitals are providing quality care. Data to assess clinical performance from the Joint Commission(JC) core measures program, which uses standardized, evidence‐based measures, and data from the Medicare program, show improvements in the quality of care in hospitals (Williams et al., 2005).

According to the The Care Continiuum Alliance (2010), disease managementis a system of coordinated health care interventions and communications for populations with conditions in which patient self‐care is significant. What makes caring for patients with chronic diseases problematic is that the patients usually have multiple chronic conditions (e.g., the patient with congestive heart failure who also has hypertension, diabetes, emphysema, urinary incontinence, and chronic pain). Heart disease, stroke, cancer, chronic respiratory diseases, and diabetes are the leading cause of mortality in the world (WHO, 2019). Common, modifiable risk factors underlie the major NCDs. They include tobacco, harmful use of alcohol, unhealthy diet, insufficient physical activity, overweight/obesity, raised blood pressure, raised blood sugar, and raised cholesterol (WHO, 2019).

Source: Adapted from Yong, P., Saunders, R., & Olsen, L. (2010). Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary [National Institutes of Health]. doi: http://www.nap.edu/catalog/12750.html

Discussion:The IOM's Roundtable on Value & Science‐Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up‐to‐date clinical information, and will reflect the best available evidence.

This summary highlights the presentations and discussions from these workshops, delving into the major causes of excess spending, waste, and inefficiency in health care. The ideas and observations presented are offered in the truism that health reform, now and in the future, will benefit from identifying actionable options to lower health care costs in ways that maximize value.

Implications for Practice:This series delves into the major causes of excess spending, waste, and inefficiency in health care. By understanding where waste exists, nurses can help reduce waste and improve patient and cost outcomes.

Another type of results reporting that is used by organizations is the balanced scorecard. A balanced scorecardis a framework to implement and manage strategy. It links a vision to strategic objectives, measures, targets, and initiatives. It balances financial measures with performance measures and objectives related to all other parts of the organization. They are used to monitor customer perspective; financial perspective; internal processes and human resources; and learning and growth for strategic management and as a way to examine performance throughout the organization. This examination allows the organization to review multiple key areas of performance, selected on the basis of their importance to the organization's strategic plan for quality.

The body of evidence supporting clinical practice is steadily growing. However, even when evidence‐based quality care guidelines are available for numerous conditions, for example, diabetes, congestive heart failure, and asthma, they have not been fully implemented in actual patient care, and variation in clinical practice is abundant (IOM, 2001; McGlynn et al., 2003; Timmermans & Mauck, 2005). Health care knowledge continues to expand. This requires practice guidelines and the measures of quality on which they are based to be continually updated. It also requires attention to continuing to develop health care quality.