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Board quality scorecards: measuring improvement
Christine A Goeschel1, Sean M Berenholtz, Richard A Culbertson
1Tulane University, New Orleans, LA, USA. Cgoesch1@jhmi.edu
Insights
Hospital boards need better tools to measure quality and patient safety. Current methods often identify risks rather than track improvement, highlighting the need for valid outcome measures for effective oversight.
Area of Science:
- Healthcare Management
- Patient Safety Science
- Quality Improvement Metrics
Background:
- Board accountability for healthcare quality and patient safety is established, but measurement science is underdeveloped.
- Distinctions between performance measurement, hazard identification, and progress monitoring are frequently unclear.
- Hospital scorecards used by boards lack evidence of validity due to absent national standards.
Purpose of the Study:
- To identify the quality monitoring measures utilized by hospital boards.
- To assess the validity and utility of these measures for board oversight.
- To inform policy regarding board roles in quality improvement.
Main Methods:
- Cross-sectional study involving hospital boards.
- Analysis of measures used by boards to monitor quality and patient safety.
- Evaluation of measure validity and focus (hazard identification vs. rate measurement).
Main Results:
- Significant variation in quality monitoring measures across hospital boards.
- Many measures demonstrated uncertain validity, primarily identifying hazards instead of quantifying rates.
- Limited evidence supports the usefulness of current measures for assessing quality improvement.
Conclusions:
- Hospital boards require more valid outcome measures to effectively monitor quality and patient safety progress.
- Current measurement limitations impact national and hospital-level assessments of quality improvement.
- Policy development is needed to enhance board oversight capabilities through improved metrics.
Abstract:
Board accountability for quality and patient safety is widely accepted but the science for how to measure it is immature, and differences between measuring performance, identifying hazards, and monitoring progress are often misunderstood. Hospital leaders often provide scorecards to assist boards with their oversight role yet, in the absence of national standards, little evidence exists regarding which measures are valid and useful to boards to assess quality improvement. The authors describe results of a cross-sectional board study, identifying the measures used to monitor quality. The measures varied widely and many were of uncertain validity, generally identifying hazards rather than measuring rates. This article identifies some important policy implications regarding boards' oversight of quality and acknowledges existing limits to how we can measure quality and safety progress on the national or hospital level. If boards and their hospitals are to monitor progress in improving quality, they need more valid outcome measures.
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