Measuring quality to drive improvement


Regular measurement and analysis of quality measures is a core principle of all improvement work; however, measuring quality is not simple in any setting, as highlighted in a recent article in the Journal of the American Medical Association: “Quality measurement is in rapid flux….despite the challenges of a rapidly expanding number of quality measures, much of health care remains poorly measured or unmeasured” (Panzer et al. 2013).

Measures of quality can encompass any of the quality aims discussed earlier, including timeliness of care (waiting time), clinical effectiveness of care (compliance with standards), safety of care (frequency of adverse events), equity of care (care utilization by subpopulations), efficiency (cost per outcome achieved), and others. Often stakeholders think only of effectiveness (adherence to best practices) when they hear the word “quality,” yet other measures can be equally important.

It is useful to consider which stakeholders need which quality of care information and for what purpose. For example, community- and facility-based health workers may benefit from tracking process measures related to the quality of specific services they provide. District and regional managers may benefit from tracking performance of essential system functions at the district level, such as distribution of commodities and functionality of referral systems, in addition to tracking a few sentinel quality of care process measures in the facilities they supervise.

National policy makers may find it most useful to track health outcome measures and incorporate a few sentinel measures of quality into routine information systems so as not to burden the health management information system (HMIS) with too many indicators.