Balancing accountability and improvement: a case study from Massachusetts

The Massachusetts Health Quality Partnership (MHQP), a coalition of health care providers and insurers, and business and government organizations, conducted a voluntary statewide survey about patients' experiences with inpatient care at Massachusetts hospitals in 1998, and made the results public.

MHQP contracted with The Picker Institute (Boston) to conduct the statewide survey about seven dimensions of care for adult medical, surgical, and maternity patients at 58 hospitals across Massachusetts. The communications strategy for public report release was designed to promote fair reporting by the news media and emphasize the improvement goals of performance measurement above evaluation. Along with critical agreements on report design, trial surveys, advertising, and commitments from coalition members about the use of survey results, these measures sought to drive out fear of participation and unfair evaluation.

Statewide news media coverage reflected the project's communications goals. Editorial praise for the report was widespread. The project stimulated numerous hospital quality improvement efforts and focused hospital leaders on the need to improve patients' experiences with hospital care. All participating hospitals voluntarily renewed their enrollment for a third survey and public report cycle, and new hospitals joined the project.

Voluntary public release of performance information by health care providers is possible when the risks, motivations, rewards, and penalties of measurement and public reporting are understood and carefully managed. The goals of public accountability reporting will be realized sooner when it is wedded to the spirit of continuous quality improvement and when providers are engaged as partners at every step of the measurement and reporting process.