Author Debra Malina, PhD, a perspective editor at NEJM, draws parallels between the drive for accountability and top-down performance measures in education and in healthcare. For example, many schools assess teachers based on students’ performance on standardized tests, and hospitals’ reimbursement is now affected by patient outcomes, such as readmissions.
Instead, a bottom-up approach that engages teachers and physicians may be more effective in designing measures and improving performance. Dr. Malina provides examples of bottom-up performance measures in healthcare:
• Quality metrics annually reviewed by a colleague
• Measures with no right or wrong rate, such as the number of radiology tests per 1,000 patients
• Effectiveness of physician communication about diagnosis and treatment
• Coordination of care between physicians and nurses
• Adequacy of pain control
She shared some lessons from education’s accountability efforts that healthcare leaders can learn from:
1. Measure outcomes that have inherent value for providers.
2. Use multiple measures for both processes and outcomes.
3. Do not expect immediate changes from financial incentives.
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