Standardize concepts, not tools for quality improvement

Pay for performance has become a new mantra in the ongoing efforts to improve the quality of healthcare and stabilize healthcare costs. In response to complaints of employers and others, numerous organizations have emerged to try and standardize the tools used to measure quality. This article maintains that such an approach will not lead to improvement in quality. Rather, we should be standardizing on specific quality of care concepts, such as hospital satisfaction or bypass graft mortality. In turn, appropriate federal agencies should calibrate (or translate) well-validated tools measuring desired concepts. This would allow consumers to take action on quality reports calibrated to allow comparison of results based on a standardized concept such as hospital satisfaction but which in turn contains results using different, well-validated satisfaction questionnaires. This article provides a road map for the implementation of a process of standardizing on concepts rather than tools.