Using performance measurement to drive improvement: a road map for change

Performance measures and reporting have not been adopted throughout the US health care system despite their central role in encouraging increased participation by consumers in decision-making. Understanding whether the failure of measurement and reporting to diffuse throughout the health system can be overcome is critical for determining future policy in this area.

To create a conceptual framework for analyzing the current rate of adoption and evaluating alternatives for accelerating adoption, and to recommend a set of concrete steps that can be taken to increase the use of performance measurement and reporting.

Review of three theoretic models (Rogers, Prochaska/DiClemente, Gladwell), examination of the literature on previous experiences with quality measurement and reporting, and interviews with select stakeholders.

The three theoretic models provide a valuable framework for understanding why the use of performance measures is stalled ("the circle of unaccountability") and for generating ideas about concrete steps that could be taken to accelerate adoption. Six steps are recommended: (1) raise public awareness, (2) redesign measures and reports, (3) make the delivery of information timely, (4) require public reporting, (5) develop and implement systems to reward quality, and (6) actively court leaders.

The recommended six steps are interconnected; action on all will be required to drive significant acceleration in rates of adoption of performance measurement and reporting. Leadership and coordination are necessary to ensure these steps are taken and that they work in concert with one another.