Continuous Improvement as an Ideal in Health Care

Berwick, Donald M.

doi:10.1056/nejm198901053200110

Cited by 1,471 publications

(634 citation statements)

References 3 publications

Supporting

Mentioning

588

Contrasting

Unclassified

Order By: Relevance

Section: Improving Performance Measuresmentioning

confidence: 99%

“…The complexity of health care makes it implausible that performance indicators could be developed for everything, or even that performance measurement alone can improve quality broadly. Rather, performance measurement should be seen as only one aspect of quality improvement, 25 and perhaps a narrow one.Performance measurement and pay for performance are well-intentioned and almost surely part of the right answer toward improving health care. They are easily oversold, however, and alone they risk directing our attention to what is measurable rather than what is important.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical Concerns About Clinical Performance Measurement

Werner¹,

Asch²

2007

The Annals of Family Medicine

View full text Add to dashboard Cite

Performance measurement has become one of the foundations of current efforts to improve health care quality and has successfully increased compliance with practice guidelines in many settings. Despite the successes of performance measurement, many physicians remain apprehensive about its use because performance measurement "gets in the way of" delivering good care. There are several reasons clinicians might feel this way. First, performance measurement is increasingly being extended to areas that have only a small clinical benefi t and thus risk diverting attention from other more important but unmeasured aspects of care. Second, most performance measurement systems provide no priority for following guidelines likely to yield a large clinical benefi t compared with guidelines likely to yield at best a small clinical benefi t. Third, performance measures focus physicians' attention narrowly on compliance with those measures rather than more broadly on the needs of the individual patient. Because performance measures are evaluated at the level of the indicator, they may crowd out quality at the level of the patient that is equally important but that cannot be easily measured. Performance measures play an important role in improving health care quality and will undoubtedly continue to do so; however, they are only one part of the solution to improving health care quality. Good performance is not necessarily good care, and pressure to improve performance can come at the sacrifi ce of good care. In its current state, performance measurement is better suited to improving measured care than improving the care of individual patients. INTRODUCTIONP erformance measurement has become one of the foundations of current efforts to improve health care quality. The concept underlying this approach is that clinical performance will improve by setting standards for clinical processes or outcomes and measuring performance against those standards. The idea is borrowed from industrial approaches to quality improvement and has great intuitive appeal because it has the potential to link practice with evidence and standardize care.There is compelling evidence that performance measurement leads to performance improvement. For example, in 1995 the US Department of Veterans Affairs began measuring and providing feedback on performance along selected clinical indicators in screening, prevention, and treatment of common disorders. 1 Pneumococcal and infl uenza vaccination rates more than doubled as a result, and substantial improvements were made in rates of appropriate diabetes management. 2 As the successes of performance measurement have become clear, performance measures have proliferated and now cover a progressively larger portion of clinical care in many health care settings. Indeed, the potential for quality improvement is seen to be so great that measured performance is increasingly being used in the United States and elsewhere, not only to provide 160CLINIC A L PER F OR M A NCE ME A SUR EMENT quality-of-care information ...

show abstract

Section: Improving Performance Measuresmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Concerns About Clinical Performance Measurement

Werner¹,

Asch²

2007

The Annals of Family Medicine

View full text Add to dashboard Cite

show abstract

“…Quality assurance in health settings has often taken the form of the hunt for the 'bad apple', rather than a cooperative learning exercise (Berwick 1989). The exercise described in this paper is a genuine attempt to achieve communal learning and, to a large extent, that has been achieved.…”

Section: Introductionmentioning

confidence: 99%

Turning around patient complaints in a regional hospital

Douglas

Harrison²

1996

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…Moreover, hospital leaders face the additional challenge of developing policies, procedures, and incentives to improve quality within a domain that has traditionally been the province of highly autonomous professionals. Quality improvement (QI) practices have emerged in recent years partially as an alternative to quality assurance and as a reaction to the shortcomings of outcome-based control strategies (Berwick, 1989;Berwick, 1990;James, 1990;Laffel & Blumenthal, 1989). With mounting pressure to maintain or improve quality in the face of reduced resources, hospitals have been encouraged to look to process improvements as a mechanism to provide high quality care while containing healthcare costs (Casalou, 1990;King, 1990).…”

Section: Organizational Contextmentioning

confidence: 99%

Quality improvement and hospital financial performance

2006

View full text Add to dashboard Cite

SummaryThe objective of this study was to examine the association between the scope and intensity of Quality improvement (QI) implementation in hospitals and organizational performance. A sample of 1,784 community hospitals was used to assess relationships between QI implementation approach and two hospital-level performance indicators: cash flow and cost per case. Two-stage instrumental variables estimation, in which predicted values (instruments) of eight QI intensity and scope variables plus control (exogenous) variables were used to estimate hospital-level performance indicators. Our results suggest that QI has a measurable impact on global measures of organizational performance and that both control and leaning approaches to QI matter in these settings. Hospitals that implement QI effectively can reasonably expect to improve their financial and cost performance, or at least not place the hospital at risk for investing in quality improvement. These outcomes are specific to QI strategies that emphasize both control and learning.

show abstract

Continuous Improvement as an Ideal in Health Care

Cited by 1,471 publications

References 3 publications

Clinical Concerns About Clinical Performance Measurement

Clinical Concerns About Clinical Performance Measurement

Turning around patient complaints in a regional hospital

Quality improvement and hospital financial performance

Contact Info

Product

Resources

About