MEASURING ASPECTS OF ORGANIZATIONS PANEL

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MEASURING ASPECTS OF ORGANIZATIONS PANEL

• Jeff Alexander
• Ross Baker
• Paul Cleary
• Kelly Devers
• Shoshanna Sofaer
• Steve Shortell

AcademyHealth San Diego, CA June 7, 2004
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Making change possible
CARE SYSTEM

• Outcomes
• Safe
• Effective
• Efficient
• Personalized
• Timely
• Equitable

Supportive payment and regulatory environment
Organizations that facilitate the work
of patient- centered teams
High performing patient- centered teams

• REDESIGN IMPERATIVES SIX CHALLENGES
• Redesigned care processes
• Effective use of information technologies
• Knowledge and skills management
• Development of effective teams
• Coordination of care across patient conditions,
  services, and settings over time.
• Use of performance and outcome measurement for
  continuous quality improvement and accountability

Source Institute of Medicine, Crossing the
Quality Chasm, p. 127, 2001.
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Source Adopted from Ferlie, W.B. and S.M.
Shortell (2001). Improving
Quality of Health Care in the United Kingdom and
the United States A Framework for Change.The
Milbank Quarterly 79(2).
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SOME ISSUES AND CHALLENGES

• Capturing complexity
• Multi-level measurement issues
• Aggregation issues
• Unit of analysis issues
• Measuring change

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IMPORTANCE OF A SYSTEM APPROACH TO MEASUREMENT

• Healthcare systems, as they manifest in the
  everyday workplace of hospitals, and physician
  offices, are felt to represent complex adaptive
  rather than mechanical systemsone in which the
  parts have potential to respond differently and
  unpredictably at a given point in time.

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IMPORTANCE OF A SYSTEM APPROACH TO MEASUREMENT
(Cont.)

• These system parts can also move each other to
  act in specific ways. Most empirical studies
  (of medical errors)did not take a systems
  approach. Rather they examined single variables
  such as teams or leadership without considering a
  larger, more inter-connected web of
  organizational dynamics in their analysis.

Source T. Hoft et al. Organizational Factors,
Medical Errors, and Patient Safety, Medical
Care Research and Review, March, 200422-23.