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Steering by outcomes

Steering by outcomes: measurement and feedback 

Richard Bohmer of Harvard Business School identifies a number of habits of high performing organizations including: the measurement and oversight of clinical work and self-study. The best organizations are collecting more information about processes and outcomes than those required by regulators and other external reporting and they use this to drive improvement. The end point is to steer the organization by outcomes – for example measuring infection rates rather than adherence to hand hygiene policy. There is some way to go before this is a reality.

The best organizations use their internally generated data to test ideas for improvement and to generate new knowledge about what works and change their practice. This requires staff that are clear about value (habit 1), empowered and trained to make improvement (habit 2) and have the tools to specify and design high quality care (habit 3). The measurement and feedback habit re-enforces this culture of improvement.


In the case studies we can see how Circle and Avarind use the monitoring and sharing of outcomes with professionals to create a drive for improved outcomes.


Similarly, by monitoring patient satisfaction and overall costs of care, Buurtzorg have managed to demonstrate to payers that their business model (employing more expensive nurses, in self-steering teams) is more cost effective and works.

Case Studies


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