title: How to develop a business case for quality.
abstract: OBJECTIVE
  To describe the steps in developing a business case for quality-enhancing interventions (QEIs) in health care.
  
  
  METHODS
  The development of a business case for QEIs in health care involves 11 steps. These steps include (1) describing the intervention, (2) determining perspective, (3) identifying the effects of the intervention on quality, (4) designing the study, (5) identifying and measuring cash flows, (6) considering the effects of capacity constraints, (7) selecting a measure of return on investment, (8) determining the time horizon for the analysis, (9) determining the discount rate, (10) adjusting costs and savings for inflation, and (11) determining organizational readiness for business case development. A checklist offers guidance on assessing readiness for the business case.
  
  
  CONCLUSIONS
  The absence of a 'business case' for quality is frequently cited as the reason health care organizations do not implement QEIs, despite decades of careful research demonstrating their effectiveness. Our continuing commitment to advancing the discipline of business case analysis is based on a belief that delineating the cost and economic implications of investments in QEIs is a critical threshold issue to widespread adoption of evidence-based quality improvements. We believe it is appropriate and timely to consider how best to standardize approaches and move the field of business case analysis forward.
authors.affiliation: Department of Health Policy and Administration, 1104H McGavran-Greenberg Hall, CB #7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA. reiter@email.unc.edu
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Reiter
authors.forename: Kerry E
authors.initials: KE
authors.lastname: Kilpatrick
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Greene
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Lohr
authors.forename: Sheila
authors.initials: S
authors.lastname: Leatherman
mesh_terms: D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D006268:Health Facilities; D006801:Humans; D010565:Persuasive Communication; D011785:Quality Assurance, Health Care; D014481:United States