The perceived impact of public reporting hospital performance data: interviews with hospital staff

Abstract

Public reporting of performance measure data appears to motivate and energize organizations to improve or maintain high levels of performance. Despite commonly cited concerns over the limitations, validity and interpretability of publicly reported data, the heightened awareness of the data intensified the focus on performance improvement activities. As the healthcare industry has moved toward greater transparency and accountability, healthcare professionals have responded by re-prioritizing hospital quality improvement efforts to address newly exposed gaps in care.

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…Furthermore, differences in context can result in the intervention not working through the intended mechanisms, leading to unintended consequences. 74 For example, the feedback and public release of performance data may stimulate improvement activity at hospital level through increased the involvement of leadership or a refocusing of organisational priorities, 75 but it has also been shown to lower morale, and may focus attention on what is measured to the exclusion of other areas. 18 Others have cautioned that it may also lead to surgeons refusing to treat the sickest patients to avoid poor outcomes and lower publicly reported ratings.…”

“…Thus, the study was at risk of numerous potential sources of reporting bias; frontline staff may not have felt able to express contrasting views to those of senior managers. The authors report that 'in interviews involving both leadership and frontline staff, more detailed responses to questions were proffered by those in leadership roles with front line staff affirming response either with non-verbal cues or simple one word responses', 75 suggesting that 'chatty bias' might have been at play here. As such, findings are more likely to represent the views of managers than frontline staff.…”

“…For example, an administrator indicated 'When you tell a surgeon his numbers are going to be out there, you get their attention and they ask what they need to do!'. 75 Similarly, nurses from a low-performing hospital indicated that public reporting had 'forced us to look at it [the data], to compare it. Before, it just sat there, now it drives us to do better' and that 'knowing that the public is aware of the scores makes us more energised to do better'.…”

“…Before, it just sat there, now it drives us to do better' and that 'knowing that the public is aware of the scores makes us more energised to do better'. 75 The findings suggest that media scrutiny of the data put pressure on staff to respond to them, as one administrator noted: 'I don't think anyone believed it was going to be public until the newspaper article -that's when people gasped!'. 75 Media scrutiny was perhaps felt more strongly for lower-performing hospitals, as interviewees felt that the local media typically tended to focus on 'why the numbers are low and rarely on why they are high'.…”

Management practices in Australian healthcare: can NSW public hospitals do better?

“…However, a major impediment towards analyzing management practices within health care systems has been the lack of reliable empirical data on hospital management practices. The few studies that have been published are centered on specific aspects of management, such as operations management (McDermott and Stock, 2007;Vos et al, 2007), performance management (Giuffrida et al, 1999;Hafner et al, 2011), target management (Geelhoed and de Klerk, 2012) and people management (West et al, 2002;Hunter et al, 2000;Michie and West, 2004;Omar et al 2007) or in specific health care settings such as nursing . McKinsey & Co. attended to this research gap by designing a robust, multi-dimensional survey to measure hospital management practices in a holistic manner.…”