Responsibility for quality will likely become less reliant on individuals and more on teams. Staff should learn to embrace standardized processes trading individual for collective autonomy, leading to improved outcomes and a sharp decline in harm rates.
Regulatory demands are expected to change significantly, as providers, payers, governments and commissioners acknowledge the need to converge internal and external measurements and reporting around the key outcomes that matter most to the patient.
These outcome measures should become increasingly internationally standardized – as guidelines increasingly are also. Quality audits will likely become the norm and adopt the same standards as financial assurance, to give regulators, contractors, patients and other stakeholders confidence that reports accurately reflect real performance. Likewise, certification should focus primarily on the safety of care, assuring error rates much lower than we are now used to.
The organizations studied in this paper are all making progress along the path to high reliability and have adopted some or all of the following actions:
- Embrace the four building blocks of measurement, responsibilities and accountability, culture, and process optimization and standardization.
- Measure the outcomes that matter most to patients, and the contributing processes and intermediate outcomes.
- Assign individuals responsibility for clinical and financial outcomes of defined care processes.
- Align measurement processes with care pathways and lines of reporting.
- Create a culture that is zero tolerant to complacency, but also open and just, committed to excellence and joint learning.
- Adopt the appropriate information technology (IT) to optimize measurement and processes, but being careful not to let the lack of a proper IT infrastructure act as an excuse for inactivity.
- Focus external reporting on important patient outcomes, rather than on detailed processes and protocols.
- Continually seek ways to risk-adjust measurements, to enable better benchmarking.
- Provide independent assurance over the reliability of quality measures, via internal and external audits, applying established assurance principles.
- Choose certification as an appropriate way to assure safety, rather than public reporting of negative outcomes.
Good clinical governance requires boards to pay at least as much attention to quality issues as is paid to financial issues, and to publicly account for outcomes in these two fields in the same way.
Industry best practices for quality reporting should therefore consist of a periodically and publicly issued report that contains information that is relevant for all the stakeholders:
- that aligns objectives and information from the patient’s perspective for professionals and providers, being held to account
- that gives a true and fair view of all the relevant matters concerning the quality of care, which means that unfavorable data are also incorporated in the report
- that is based on routine-based measurement of relevant data, that are subject to internal controls, comparable with internal controls used for financial data
- that is the subject of an external audit, and for which an auditor’s report is issued.
Although there are no global standards for quality reporting in healthcare, global standards for giving assurance on non-financial reporting, such as quality data, do exist and are used in several countries where external audits and reporting on selected clinical data is required.