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Published on: February 16, 2011
Identifying unintended consequences of quality indicators: a qualitative study
Helen E Lester1, Kerin L Hannon, Stephen M Campbell
1Primary Care Group, University of Manchester, Manchester, UK. helen.lester@manchester.ac.uk
BMJ Quality & Safety
|June 23, 2011
Summary
Piloting new Quality and Outcomes Framework (QOF) indicators in UK primary care helps identify unintended consequences before implementation. This proactive approach ensures better patient care and value for money in performance schemes.
Area of Science:
- Health Services Research
- Primary Care Policy
- Quality Improvement in Healthcare
Background:
- The UK's Quality and Outcomes Framework (QOF) initially introduced indicators without piloting.
- Since 2009, potential new QOF indicators have been piloted in a representative sample of primary care practices.
- This study explores healthcare professionals' views on piloting and its impact on unintended consequences.
Purpose of the Study:
- To evaluate the value of piloting potential Quality and Outcomes Framework (QOF) indicators.
- To identify unintended consequences of new QOF indicators from the perspective of primary care staff.
- To assess the cost-effectiveness of piloting in the context of the QOF scheme.
Main Methods:
- Qualitative study involving interviews with primary care professionals.
- Interviews conducted with 57 professionals across 24 representative general practices in England.
- Exploration focused on views regarding the piloting of 13 potential new QOF indicators.
Main Results:
- Interviewees highlighted piloting's value in revealing 'real-world' unintended consequences.
- Identified unintended consequences included measure fixation, tunnel vision, misinterpretation, and potential gaming.
- 'Measure fixation' was identified as a key unintended consequence, potentially leading to poorer care.
- Piloting the palliative care indicator could have prevented harm to vulnerable patients.
Conclusions:
- Early identification of unintended consequences through piloting allows for indicator adaptation or removal.
- Piloting is a cost-effective measure, representing a small fraction of the total QOF budget.
- Investing in piloting is crucial for refining QOF indicators and safeguarding patient care quality.
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