iProtean—More on Measuring Quality

We know that many board members view their quality oversight role as elusive—and daunting. It may help to read about the broader context within which policy makers discuss various approaches to measuring quality across the organization.


Last week, we featured new criteria for measuring and proving “value.” Today, we focus on policy recommendations to improve quality measurement from Health Affairs Blog. Robert Berenson, author of the blog, notes that “performance measurement—if done right—can be a core activity to move the healthcare system to higher value [emphasis added] for the American public, while rewarding health professionals and healthcare institutions for doing the right thing for their patients.” (R. Berenson, “Seven Policy Recommendations to Improve Quality Measurement,” Health Affairs Blog, May 22, 2013.)


Mr. Berenson proposes a series of major policy steps to measure and report quality accurately and meaningfully. The hospital/health system board should be aware of this broader discussion as it assesses its organization’s approach to measuring quality.


  • Decisively move from measuring processes to outcomes.

Today, quality measurement focuses on processes rather than outcomes. But process measures are not strong predictors of outcomes “that matter,” notes Mr. Berenson.  In fact, current process measures may divert attention from work process improvements that would actually improve outcomes. Moving from process to outcome is difficult, but necessary. The end results of care, not technical approaches adopted by providers, should dominate providers’ efforts.


  • Use quality measures strategically, adopting other quality improvement approaches where measures fall short.

Mr. Berenson takes issue with value-based purchasing/pay-for-performance, noting these measures also may divert providers’ attention from efforts “to make culture and work process improvements that could produce larger improvements in outcomes.” He urges Congress to refocus its directives to CMS to more strategic performance measures that will improve specific quality deficiencies. This involves relying more on promoting collaborative quality improvement activities and new payment approaches rather than public reporting and pay-for-performance.


  • Measure quality at the level of the organization, not the clinician.

Measures should focus on team-based care rather than that of the individual clinician. This brings measurement to the organizational level, which is consistent with “population-based accountable care.” Please note, however, that performance measurement for accountable care organizations does rely on individual clinician feedback, according to Stephen Shortell, PhD, MPH, MBA. Dr. Shortell recently said that within an ACO, “performance measurement is critical at the practice level and the individual physician level to know what corrective actions to take.” (“The State of Accountable Care Organizations:  A Conversation with Health Policy and Management Expert Stephen M. Shortell, PhD, MPH, MBA,” AHRQ Health Care Innovations Exchange, May 8, 2013.)


  • Use measurement to promote the concept of the rapid-learning healthcare system.

Quality measurement data should not reside in isolation, institution by institution. These data should be shared between and among institutions to produce insights for a broader strategy to improve quality. Working together, institutions may produce insights that none could have produced on their own.


Mr. Berenson offers other policy steps—to read the full article, please click here.



iProtean subscribers, please refer to the iProtean advance course Value-Based Purchasing and Accountable Care Organizations, featuring health experts Nate Kaufman, Dan Grauman and Monte Dube. Also coming soon is the new course Employing Physicians with Nate Kaufman, Dan Grauman and Susan Douglass.



For a complete list of iProtean courses, click here.



iProtean Symposium & Workshop

Mark the Date!! October 2 – 4, 2013 at The Lodge at Torrey Pines, La Jolla, CA. Faculty: Michael Irwin (Citigroup), Todd Sagin, M.D., J.D. (Sagin Healthcare Consulting), Dan Grauman (DGA Partners), Pam Knecht (ACCORD LIMITED), Barry Bader (Bader & Associates), Ed Kazemek (ACCORD LIMITED).  For more information, click here.


For more information about iProtean, click here. www.iprotean.com/index.php/iprotean/demo