In a world first, for accreditation programs, Clinical Indicators (clinical performance measures) were introduced into the Australian Council on Healthcare Standards (ACHS) accreditation process 21... Show More

In a world first, for accreditation programs, Clinical Indicators (clinical performance measures) were introduced into the Australian Council on Healthcare Standards (ACHS) accreditation process 21 years ago. The resulting national clinical database now receives data from over 740 health care organisations (HCOs) on 22 indicator sets, for different medical disciplines, containing almost 400 separate indicators. HCOs receive aggregate and peer comparative feedback and the types of action by HCOs in response to their results include further data reviews, policy/procedure changes, education programs, new appointments and equipment changes. Favourable data trends in patient care are evident and, with some indicators, cost avoidance can be demonstrated. Revision of the indicator sets is an essential task to ensure continued relevance to clinicians. The Federal Government response to a study in which patient care in Australian hospitals was, prematurely, judged to compare poorly with care in the USA (and later the UK) resulted in the establishment of The Australian Commission on Safety and Quality in Health Care which has now embarked upon a separate program of hospital-based outcome indicators, as have other health care providers. Advice is provided from the literature and personal experience on issues of presentation of material to health care policy makers.

Clinical management and care outcome measures, which are now becoming mandatory in more and more countries, can influence the quality of care if they are relevant, evidence-based, carefully crafted... Show More

Clinical management and care outcome measures, which are now becoming mandatory in more and more countries, can influence the quality of care if they are relevant, evidence-based, carefully crafted and subjected to periodical quality review. Over a period of 13 years, a large Italian teaching hospital has used this framework to develop a performance measurement system, comprising a total of 768 internal and 67 external measures, with a view to improving service provision and accountability. The web-based performance measurement system does have a cost in terms of staffing and technological requirements, but the integration of the data it provides into the decision-making process can have a considerable impact on performance, and therefore quality of care.

Information Society the authors are a part of is the environment requesting paradigm changes in many areas of their thinking and doing. Improvement of the functionality of healthcare systems and the... Show More

Information Society the authors are a part of is the environment requesting paradigm changes in many areas of their thinking and doing. Improvement of the functionality of healthcare systems and the success of implemented strategies is a function of the volatility of the environment where they are implemented and is extremely dependent on unexpected turning points. All healthcare projects always become a policy. The difference lies only in the size of the network that is affected and in the duration of the effect. The policy (learned and accepted code of attitudes, conduct and possibly of behavior) will initially affect only the population, which formed a part of the policy setting activity (project, training). Based on 22 policies oriented projects the author participated in years 1993-2013 and illustrated in three commented projects the acknowledgement and adoption of principles, processes and attitudes found beneficial for successful policy implementation in various healthcare environments is presented.

The past three decades have primarily focused on improving performance across health care providing organizations and even individual professionals. While their interest in performance improvement... Show More

The past three decades have primarily focused on improving performance across health care providing organizations and even individual professionals. While their interest in performance improvement is global, the strategies across health care systems remain variable and the resulting methods of accountability to select audiences continue to be influenced by tradition and expectation. The purpose of this article is to review the key dimensions of the operationalization of performance measurement and the translation of its findings to statements about quality of care. While significant literature exists on the conceptual debates about the nature of quality, the deciding factor in demonstrating that better quality may have been achieved resides in the acceptability of the measurement tools to translate performance measures into profiles of quality. Fundamentally, the use of the tools is seen as only one component of a successful strategy – the education of various audiences as to what the measures mean not only is a necessary requisite for sound project design but also will determine how the accountability model is shaped in each environment based on the generic measurement tools results, local traditions of care and caring, and expectations about outcomes.