Process surveillance: an epidemiologic challenge for all health care organizations

Historically, qualitative and quantitative monitoring of patient care practices related to infection control may have been only marginally correlated with findings of nosocomial infection surveillance. More recent developments in health care have included an emphasis on "outcome management," as well as an enthusiasm for applying industrial process improvement methods. Health care organizations may choose to incorporate process surveillance as an adjunct to or a surrogate for outcome measurement. An essential characteristic of a well-designed process surveillance program is a direct relationship with clearly articulated and logically prioritized outcome objectives. To optimize value and efficacy, the program design should be consistent with the organizational strategic plan and sensitive to the needs of members of the health care team to which the data would be reported. Process data must be objectively and consistently measurable, feasible to collect, and, ideally, expressed as rates or ratios to support valid comparative analyses. Infection control professionals should approach development of process surveillance systems with a logical and organized construct.