Voluntary Reporting of Performance Data: Should it Measure the Magnitude of Events and Change?

Voluntary Reporting of Performance Data: Should it Measure the Magnitude of Events and Change?

Vahé A. Kazandjian (The Johns Hopkins University, Baltimore, USA)
Copyright: © 2018 |Pages: 11
DOI: 10.4018/IJBDAH.2018010103

Abstract

Reporting safety of care data is now a global imperative. Performance improvement strategies, however, often reflect the requirements of the ambient healthcare system, especially with regard to the voluntary or mandatory reporting of data. The quality and completeness of the data are affected by the nature of the reporting requirement and will consequently determine the robustness of the strategies to improve safety of care. The measurement of the complete/true magnitude of events may be important for the appropriateness of safety improvement strategies and initiatives. The goal of this article is to identify the key characteristics of voluntary and mandatory safety of care data reporting systems, and their implications for performance improvement from an epidemiological, clinical and administrative points of view.
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Introduction

Understanding the safety of health care practices has evolved from solely raising awareness about the issue to exploring how complete a safety measurement can be given the requirements for measuring and reporting of performance data. While there is little debate about the generic nature of errors, i.e., they happen in every health care delivery organization, the true incidence as well as prevalence of errors remains questionable since many are thought to be unreported even through systems that define errors rigorously. (Kohn et al., 2000; Leap, 2000) The Institute of Medicine’s (IOM) landmark report, “To Err is Human: Building a Safer Health System,” suggested an incidence rate of adverse events of less than three percent (Kohn et al., 2000) a proportion of which are expectedly due to errors (Aspden, 2004)). Since then, numerous studies have shown a range of errors spanning up to 20 percent, although the definition of an error varied across studies (Sendlhofer, 2018) that overwhelmingly analyzed errors of commission while errors of omission were rarely captured.

The importance of disclosure relates both to the accountability healthcare, the ultimate social good and service, has promised to the recipients of its services. There are two dimensions for this accountability promise: that the services were appropriate, and that the services were provided with the recipient’s safety foremost in mind. Disclosing errors represents yet another dimension of the safety movement where there is noteworthy variability between those expected to be accountable for their services and those who increasingly demand to be informed about the goodness of those services. One comprehensive study focusing on the views of hospital leaders depicted an image of readiness by hospitals and their leaders to measure errors and near errors but showed reluctance to agreeing on a unique way of disclosing them (Janak, 2018). A central concern of those leaders is explored in this paper to assess the extent to which methods of measurement (patient or event-based vs. organization-based rates) within systems of disclosure (voluntary vs. mandatory) promote ameliorations in the practice of health care with specific emphasis on the improvement of safety through the application of better practices. The amelioration of practices is proposed to be along two dimensions namely the processes of service provision and the application of evidence-supported practices to result in desirable outcomes while minimizing or eliminating errors during the process.

Purpose and Goal

The first purpose of this paper is to explore how measuring adverse event rates using different units of analysis (patient-event-based or organization-based rate) may yield not only different profiles of performance but could affect the strategies (processes of service production based on evidence about better practices) of improvement within a health care organization. Within this context, the importance of measuring the true incidence or prevalence of events as they pertain to internal organizational improvements will be reviewed.

The second purpose of this paper is to compare quality measurement and improvement philosophies to enhancing the safety of care, and identify differences when present.

Finally, it is the goal of this paper to identify strategic implications of the various measurement methods for performance improvement and accountability.

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Specific Questions And Rationale

There are two specific questions addressed in this paper:

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