From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.
BACKGROUND
As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety.
The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting.


CONCLUSIONS
If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality.
J Matthew
JM
Austin
Renee
R
Demski
Tiffany
T
Callender
K H Ken
KH
Lee
Ann
A
Hoffman
Lisa
L
Allen
Deborah A
DA
Radke
Yungjin
Y
Kim
Ronald J
RJ
Werthman
Ronald R
RR
Peterson
Peter J
PJ
Pronovost
D000066:Accounting / Q000592:standards; D054869:Clinical Audit; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D004469:Economics, Hospital; D005376:Financial Management; D019981:Health Care Sector / Q000191:economics / Q000458:organization & administration; D006302:Health Services Research; D006761:Hospitals / Q000592:standards; D006801:Humans; D008396:Maryland; D061214:Patient Safety; D011787:Quality of Health Care; D014481:United States