Improving Quality of Care by Measuring Performance

Background/Objective – It is widely recognized that quality indicators or performance indicators can give a valuable insight into the quality of care being provided to patients. It may not always prove easy to agree on such indicators, or to get individuals to agree willingly to be measured against such indicators. We aim to highlight the importance of linking institutional quality indicators to the performance of individuals and to show how this has helped improve the quality of care provided in our institution. Methodology – The first step was to prepare a list of hospital wide and specialty based indicators aimed at measuring the quality of care provided to patients. Readmission within 7 days of previous discharge – for oncology & internal medicine specialties, and readmissions within 30 days for surgical & anesthetic specialties are two examples of indicators developed to assess quality of clinical care; the percentage of single admissions with multiple (unplanned) surgical procedures is another. Once the definitions and measuring principles of these indicators were outlined, the next step was to identify the performance dimensions in which these indicators could be placed. Quality of clinical work, Quantum of work and Adherence to hospital protocols are a few examples of such dimensions. Optimal / allowed numbers and corresponding scores were defined for each indicator and for each specialty. Indicators applicable to individual physicians in every performance dimension were measured, and scored. The results of this objective performance evaluation were shared with each individual and its impact on the overall quality of care provided by the hospital highlighted. Results – The practice of measuring a physician’s performance with the help of the objective quality indicators was very well accepted; it not only automatically brought everyone to participate in this improvement process, thus generating a ICQI-Lahore, 2-3 May 2011 complete buy-in to the concept of measuring the quality of care provided by them, but also brought many ideas on how this could be further enhanced, and indicators that can be used in future to gauge various other aspects of quality of care delivered to the patients. Conclusion – Performance indicators are best way to learn and improve, but to instill ownership in the heart of every individual is the key to having meaningful indicators. Thus making performance indicators a part of a physician’s performance evaluation not only ensures that they actively participate in improving their own performance, but also ensure that quality of care provided to the patients is always and continuously improving.