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

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.

Specific Questions And Rationale

There are two specific questions addressed in this paper: