Once quality is defined, the prudent purchaser seeking to obtain quality must express those definitions in purchasing specifications and work with contractors to meet them. These specifications spell out for potential vendors what the purchaser's expectations are. My agency's health plan purchasing specifications, for instance, cover structure, process, and outcomes. They include access, network management, clinical and quality management, reporting, financial stability, and financial management-all the elements of quality as we see it. An important aspect of defining quality is deciding how to measure it.
Measurement is the key to prudent purchasing.
Without it, there is no way to determine whether quality was obtained, and no way of managing toward higher quality. The measures we use today in health care are rudimentary. The challenge of prudent purchasing is to push the entire world of health care in the direction of developing meaningful measures of quality. They are a beginning. But better, more outcome-oriented measures are needed.