Measurements to evaluate the existing healthcare practices and their outcomes are critical elements of the model for improvement. The quality and safety measures can be used in assessing the performance of separate clinical settings and the healthcare system as a whole. The standard adopted by the Veterans Administration Hospital in mental health for reducing the occurrence of medical errors included asking patients for two forms of identification and real-time notifications, which allowed tracking the changes in patients’ status.
A set of health system measures can be found in the Crossing the Quality Chasm Report developed by the Institute of Medicine (Science of improvement: Establishing criteria n.d.). The main characteristics of these measures include safety, effectiveness, efficiency, patient-centeredness, timeliness, and equitability, which allow using for evaluating the overall quality of the health care system. Depending upon the primary purpose and orientation, measures can be divided into three main subgroups: outcome, process, and balancing efforts.
The outcome measures are used for evaluating the impact of health care practices upon the well-being of patients and other stakeholders. The process measures allow assessing the appropriateness and effectiveness of specific steps and processes and detecting whether the implemented changes improve. As to balancing efforts, this type of measure is used for detecting whether the changes and improvements in one sphere do not cause problems in another part of the system. Thus, a complex approach should be taken to use a balanced set of measures and look at a health system from different dimensions.
The organizations supporting the implementation of quality and safety measures include the Ambulatory care Quality Alliance (AQA), the American Academy of Family Physicians (AAFP), the Agency for Healthcare Research and Quality (AHRQ), and others (Recommended starter set: The ambulatory care quality alliance n.d.). During a meeting in January 2005, a starter set of performance measures as outlined by the AQA Performance Measurement Workgroup. The National Committee holds copyright in performance measures for Quality Assurance (NCQA) (Recommended starter set: The ambulatory care quality alliance n.d.). Other organizations cannot modify the steps.
At the same time, the measures can be reproduced by anyone desiring on the condition that they are not altered and used for noncommercial purposes only. Considering that the hospitals’ reimbursement is aligned with their compliance with the quality/safety measures, it can be stated that hospitals are encouraged to adopt appropriate measures and report the corresponding outcomes.
The failure to adopt performance measures in hospital settings can be caused by the lack of attention towards performance improvement. This failure can result in poor quality of the provided services compared to other organizations that have adopted the quality/safety measures. Consequently, not implementing the quality/safety measures reduces the chances of providing the patients with the highest possible quality of services and ensuring their freedom from accidental injuries and medical mistakes. Successful implementation of the model for improvement is impossible without adopting a balanced set of performance measures. Making specific changes in the existing healthcare practices, hospitals have to adopt measures to track the achieved results and detect whether the chosen modifications can lead to improvements in all system dimensions.
The performance measure adopted by the Veterans Administration Hospital in mental health allowed reducing the occurrence of medication errors, namely those of interviewing a wrong patient and overlooking the changes in the patient’s status due to the imperfection of electronic databases. Though implementing innovative methods can help improve health care outcomes, computerization can cause many problems that require additional attention to the timely input of new data and updating the databases.