Accountability Through Measurement

Vahe A. Kazandjan

Description

Accountability Through Measurement: A Global Healthcare Imperative looks at the need for healthcare organizations to become more accountable for their performance. The book discusses the necessary mindset, structures, tools, and communication modes needed for healthcare to be accountable to itself, as well as to external audiences, about its own performance. At the heart of this is the need for a greater degree of disclosure, which in turn requires rigorous methods of measurement. This book places the requirement of disclosure at the center of the accountability mandate and presents concrete ways in which performance can be measured, analyzed, communicated, and used toward performance improvement. This approach does not place the responsibility of accountability on the providers only but makes it a joint effort between the providers and recipients.

Sujets

• Business
• Qualité, hygiène, sécurité, environnement
• Sciences formelles
• Mathématiques appliquées
• Mathématiques appliquées
• Techniques
• Automatisation et Contrôle
• Contrôle des processus
• Automatisation
• Automate
• Sciences et techniques
• Metrology
• Measurement
• Mathematics
• MSA

Informations

• Publié par: ASQ Quality Press
• Date de parution: 13 juin 2002
• Nombre de lectures: 0
• EAN13: 9781636940519
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Accountability
through
Measurement
A Global
Healthcare ImperativeAlso available from ASQ Quality Press:
Healthcare Performance Measurement: Systems Design and Evaluation
Vahé A. Kazandjian and Terry Lied
Measuring Quality Improvement in Healthcare: A Guide to Statistical
Process Control Applications
Raymond G. Carey, PhD and Robert C. Lloyd, PhD
Improving Healthcare with Control Charts: Basic and Advanced SPC
Methods and Case Studies
Raymond G. Carey, PhD
How to Use Patient Satisfaction Data to Improve Healthcare Quality
Ralph Bell, PhD and Michael J. Krivch, CHE
Customer Driven Healthcare: QFD for Process Improvement and
Cost Reduction
Ed Chaplin, MD, and John Terninko, PhD
How to Use Control Charts for Healthcare
D. Lynn Kelley
Stop Managing Costs: Designing Healthcare Organizations around
Core Business Systems
James P. Mozena, Charles E. Emerick, and Steven C. Black
Insights to Performance Excellence in Healthcare: An Inside Look
at the Baldrige Criteria for Healthcare
Mark L. Blazey, Joel H. Ettinger, Paul Grizzell, and Linda Janczak
IWA-1:2001—Quality Management Systems: Guidelines for Process
Improvements in Health Service Organizations
ISO/AIAG/ASQ
To request a complimentary catalog of ASQ Quality Press publications,
call 800-248-1946, or visit our Web site at http://qualitypress.asq.org .Accountability
through
Measurement
A Global
Healthcare Imperative
Vahé A. Kazandjian
ASQ Quality Press
Milwaukee, WisconsinAccountability through Measurement: A Global Healthcare Imperative
Vahé A. Kazandjian
Library of Congress Cataloging-in-Publication Data
Kazandjian, Vahé A.
Accountability through measurement : a global healthcare imperative /
Vahé A. Kazandjian.
p. cm.
Includes index.
ISBN 0-87389-567-3 (Hardcover, case binding : alk. paper)
1. Medical care—Evaluation. 2. Medical care—Quality control.
I. Title.
RA399.A1 K388 2002
362.1'068'5—dc21 2002015515
© 2003 by ASQ
All rights reserved. No part of this book may be reproduced in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise, without the
prior written permission of the publisher.
10987654321
ISBN 0-87389-567-3
Publisher: William A. Tony
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viiTable of Contents
Acknowledgment and Thanks . . . . . . . . . . . . . . . . . . . . xiii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Chapter 1
The Components of the Accountability Contract . . . . . . . 1
The Performers . . . . . . . . . . . . . . . . . . . . . . . . . 2
(Step #1 in Paradigm, “Capability”) . . . . . . . . . . . 2
The Nature of the Performance Vis-à-Vis
Existing Knowledge . . . . . . . . . . . . . . . . . . . . . 3
(Step #1 in Paradigm, “Science”) . . . . . . . . . . . . . 3
The Historical Background and Performer Beliefs . . . . . . 4
(Step #1 in Paradigm, “Context”) 4
Accountability and the Art of Compromise . . . . . . . . . . 5
(Steps #2 and #3 in Paradigm) . . . . . . . . . . . . . . 5
The Relationship between Expectations and Satisfaction . . . 6
(Step #3 in Paradigm, “Measurement”) 6
The Tools of Measuring Performance . . . . . . . . . . . . . 8
(Steps #3 and #4 in Paradigm) 8
Professional and Expectation Management . . . . . . . . . . 10
(Steps #3 and #4 in Paradigm) . . . . . . . . . . . . . . 10
The Tools of Reporting Performance 11
(Step #4 in Paradigm) . . . . . . . . . . . . . . . . . . . 11
The Method of Evaluating Performance . . . . . . . . . . . . 12
(Step #5 in Paradigm) 12
The Mandate to Amend or Revoke the Contract . . . . . . . . 14
(Step #6 in Paradigm) 14
ixx Table of Contents
Chapter 2
Probability and the Appropriation of Process Evaluation . . . 17
Process As the Domain of Providers . . . . . . . . . . . . . . 17
The Logic of Continuity . . . . . . . . . . . . . . . . . . . . 18
Of Artfulness and Probability . . . . . . . . . . . . . . . . . 22
Causality,Artfulness, and Probability . . . . . . . . . . 22
The Issue of Goodness . . . . . . . . . . . . . . . . . . 24
Should Accountability Always Include Outcomes
of Care? . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chapter 3
Accountability: Challenging the Concept of the
Medical Profession . . . . . . . . . . . . . . . . . . . . . . . . 29
The Medical Profession . . . . . . . . . . . . . . . . . . . . . 30
Professional Accountability . . . . . . . . . . . . . . . . 30
Patient Volume and Performance . . . . . . . . . . . . . 31
Public Disclosure of Data . . . . . . . . . . . . . . . . . 33
Inter-Observer Reliability and Clinical Skills . . . . . . 34
Evidence-Based Medicine and Practice Guidelines . . . 35
Medical Error and Systems Thinking . . . . . . . . . . 36
Organizational Characteristics and Quality of Care . . . . . . 37
The Role of Information in Patient Empowerment
and the Doctor–Patient Relationship . . . . . . . . . 38
The CMS and the JCAHO Performance Measures Agenda . . 39
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Chapter 4
Introspective Analysis: The First Step toward a
Performance Report . . . . . . . . . . . . . . . . . . . . . . . 49
Improvement through Analysis . . . . . . . . . . . . . . . . 49
Provider Practice Style . . . . . . . . . . . . . . . . . . . . . 51
The Consequences of Provider Practice Style . . . . . . 52
Practice Style and Resource Use . . . . . . . . . . . . . 53and Harmfulness . . . . . . . . . . . . . . 53
Practice Style and Restricting Access . . . . . . . . . . 54
Uncontrolled Case Studies . . . . . . . . . . . . . . . . . . . 55
Organizational Review 55
Internal Feedback . . . . . . . . . . . . . . . . . . . . . . . 57
Changes in Practice Style . . . . . . . . . . . . . . . . . 57
The Translation of Introspective Analysis to
External Reporting 58
The Reported Performance Profiles and
Assessment of Goodness . . . . . . . . . . . . . . . 60Table of Contents xi
Chapter 5
Accountability and Report Cards . . . . . . . . . . . . . . . . 63
The Readiness of the Service-Producing Organization . . . . 64
Parents Know Best . . . . . . . . . . . . . . . . . . . . 64
The Schools that Cannot Teach . . . . . . . . . . . . . . 66
Sending the Children to a School of
Unknown Credentials . . . . . . . . . . . . . . . . . 66
Expert Intermediaries . . . . . . . . . . . . . . . . . . . . . 68
The Interpretive Roles of Educators, Public Relations
Experts, and Policy Analysts . . . . . . . . . . . . . . . . 71
Evaluation of How Audiences Use Report Cards . . . . . . . 73
Target Audiences 73
The Focus on Patient-Level Data . . . . . . . . . . . . . 73
Epidemiological Data . . . . . . . . . . . . . . . . . . . 74
User’s Ombuds . . . . . . . . . . . . . . . . . . . . . . . . . 75
The Ombuds of the Patients . . . . . . . . . . . . . . . 76
The Ombuds As “Equalizer” 76
Chapter 6
Measurement Strategies toward Accountability . . . . . . . . 79
The Usefulness of Qualitative Approaches . . . . . . . . . . 79
The Contribution of Quantitative Methods 80
Epidemiological Methods of Review . . . . . . . . . . . 80
The Dimensions of the Epidemiological Investigation
of Performance . . . . . . . . . . . . . . . . . . . . . 81
Narrow Focus Establishes Wide Coalition . . . . . . . . 84
Can We Change Outcomes? Can We
Change Satisfaction? . . . . . . . . . . . . . . . . . . 86
The Visual versus Auditory Cultures of
Performance Improvement . . . . . . . . . . . . . . . . . 88
The Contribution of Medical Sociology to the
Auditory Culture . . . . . . . . . . . . . . . . . . . . 90
Looking without Seeing, Listening without Hearing . . . 91
Data Validity . . . . . . . . . . . . . . . . . . . . . . . 92
Acuity Adjustment and Its Unintended
Consequences . . . . . . . . . . . . . . . . . . . . . 96
Chapter 7
Root Cause Analysis and Disclosure . . . . . . . . . . . . . . . 99
The Applicability of RCA in Healthcare . . . . . . . . . . . . 100
Accountability, RCA, and Disclosure . . . . . . . . . . 101
Root Cause Analysis: A Celebration Methodology . . . 102
Caveats Associated with Root Cause Analysis . . . . . . . . 103xii Table of Contents
Arrows by Any Other Name . . . . . . . . . . . . . . . . 103
Is the Sum Different than the Addition of the Parts? . . . 105
Measure Twice, Cut Once . . . . . . . . . . . . . . . . 107
Chapter 8
Reports from the Field: Studies, Observations,
and New Directions . . . . . . . . . . . . . . . . . . . . . . . . 111
A Summary of This Book’s Thesis . . . . . . . . . . . . . . 112
A Synopsis of the Case Studies . . . . . . . . . . . . . . . . 113
Report #1: A Global Governmental Objective:
How Austria’s Healthcare System Deals with
Accountability and Performance Improvement . . . . . . . 124
Report #2: The Role of Accountability i