Status check: are we managing performance or managing performance data?

MORE THAN A DECADE AGO, I conducted an extensive review of the literature on external reporting of hospital performance data. Key takeaways from that review included the following: (i) there is a lack of consensus about what to measure and report, (2) existing information resources and databases are inadequate and inaccurate with regard to constructing desired measures, (3) there are concerns about the validity and reliability of available indicators, and (4) high costs are associated with measuring performance and preparing reports (Slovensky 1996; Slovensky, Fotder and Houser 1998). My naive belief was that these issues would be resolved in a very few years. I expected healthcare executives to address the operational issues of technology and expense, health services researchers to conquer the statistical challenges, and one or more regulatory or advocacy groups to establish a standardized reporting framework. Subsequently, healthcare organizations would achieve strategic benefits from making performance data available to purchasers and consumers of healthcare services. In turn, purchasers and consumers would be empowered with information to make better healthcare decisions. Unfortunately, as Patrice Spath's current literature review suggests, none of these issues has been resolved. In fact, the pessimists among us might conclude that only moderate progress has been made in any category. Nevertheless, extraordinary resources have been expended systemwide in pursuit of the "best" (or at least "good") indicators of provider performance, in building robust information management capabilities, and in establishing communication forums to connect providers, purchasers, and consumers. Seemingly, none of the players questions the inherent value in measuring and reporting performance data, but the "what and how" remain problematic. This issue's lead articles provide a status report on performance measurement and management from two useful perspectives: a recommendation for what we should be doing based on current knowledge and an example of what we are doing and how it's working for us. As is her wont, Spath provides practical advice for healthcare executives, discussing rational decision criteria for investing organizational resources to create a measurement system to meet internal and external needs. The report by Ron Anderson, Ruben Amarasingham, and S. Sue Pickens of how clinical quality is managed at Parkland Hospital & Health System is consistent with Spath's recommendations, but adds rich contextual information to the big picture. WHAT TO MEASURE AND (MAYBE) REPORT Tomorrow's healthcare leaders, that is, current students and recent graduates of academic programs, are taught to establish performance indicators to measure achievement of strategic goals (Swayne, Duncan, and Ginter 2006), some of which will articulate the organization's quality positioning. From a market perspective, the ability to benchmark or compare one's performance against that of competitors may be essential. Our lead authors agree that performance measurement must meet regulatory, purchaser, and accreditation requirements, in addition to supporting the organization's strategic agenda. Healthcare executives truly are faced with a "measurement monster" if all these information needs differ. All too often we feed the monster by trying to meet the needs of all rather than making deliberate decisions about key stakeholders and negotiating information sharing with strategic partners. And in doing so, we relearn that measurement, like quality, is an unending journey. Not only are robust measures difficult to construct, but issues of data availability and data quality further complicate the design process. In addition, the number of external reporting initiatives to which organizations can subscribe is legion and ever changing, and a significant number are mandated. In fact, for smaller organizations with limited resources, complying with measurement mandates may preclude, or severely limit, any facility initiatives. …