Connections between quality measurement and improvement.
BACKGROUND
Measurement is necessary but not sufficient for quality improvement. Because the purpose of the national quality measurement and reporting system (NQMRS) is to improve quality, a discussion of the link between measurement and improvement is critical for ensuring an appropriate system design.


OBJECTIVE
To classify approaches to the use of measurement in improvement into two different--although linked and potentially synergistic--agendas, or "pathways." To discuss the barriers encountered in each of these pathways and identify steps needed to motivate improvement in both pathways.


METHODS
Descriptive, conceptual discussion.


RESULTS
The barriers to the use of information to motivate change include, in Pathway I (selection), the lack of skill, knowledge, and motivation on the part of those who could drive change by using data to choose from among competing providers, and, in Pathway II (change in care delivery), the deficiencies in organizational and professional capacity in health care to lead change and improvement itself.


CONCLUSIONS
Neither the dynamics of selection nor the dynamics of improvement work reliably today. The barriers are not just in the lack of uniform, simple, and reliable measurements, they also include a lack of capacity among the organizations and individuals acting on both pathways.
Berwick
Donald M
DM
Institute for Healthcare Improvement, Boston, Massachusetts 02215, USA. dberwick@ihi.org
James
Brent
B
Coye
Molly Joel
MJ
D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007857:Leadership; D015279:Organizational Culture; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D016896:Treatment Outcome; D014481:United States