Sheila Leatherman

Public disclosure of performance data: learning from the US experience

The medical profession has, until recently, largely dictated standards of medical practice. If doctors completed their training and became licensed by the state they were trusted by the general public to provide clinical care with minimal obligation to show that they were achieving acceptable levels of performance. Several factors have caused this situation to change. A societal trend towards greater openness in public affairs has been fuelled by the ready availability of information in many areas of life outside of the health sector. A slow realisation of wide variation in practice standards1, 2 and occasional dramatic public evidence of deficiencies in quality of care3, 4 have led to demands by the public and government for greater openness from healthcare providers. The availability of computerised data and major advances in methods of measuring quality5 have allowed meaningful performance indicators to be developed for public scrutiny. The result has been advocacy for the use of standardised public reports on quality of care as a mechanism for improving quality and reducing costs.6–8 Publication of data about performance is not, however, new. In the 1860s Florence Nightingale highlighted the differences in mortality rates of patients in London hospitals,9 and in 1917 an American surgeon complained that fellow surgeons failed to publish their results because of fear that the public might not be impressed with the results.10 In most developed countries there is now an increasing expectation that healthcare providers should collect and report information on quality of care, that purchasers should use the information to make decisions on behalf of their population, and that the general public has a right to access that information. Organisations in the US have been publishing performance data, in the form of “report cards” or “provider profiles”, for over …

Selecting Indicators for the Quality of Health Promotion, Prevention and Primary Care at the Health Systems Level in OECD Countries

This report presents the consensus recommendations of an international expert panel on indicators for health promotion and primary care. Using a structured review process, the panel selected a set of 27 indicators to cover the three key areas health promotion, preventive care and diagnosis and treatment in primary care. The report describes the review process and provides a detailed discussion of the scientific soundness and policy importance of the 27 indicators as follows ... Ce rapport presente les recommandations consensuelles d’un groupe d’experts internationaux sur les indicateurs relatifs aux soins primaires et a la prevention. En suivant une methodologie detaillee, le groupe d’experts a selectionne 27 indicateurs devant couvrir les trois grands domaines suivants : la promotion de la sante, la prevention, le diagnostic et le traitement dans les soins primaires. Le rapport decrit la methodologie employee et demontre, arguments a l’appui, la viabilite scientifique et l’importance strategique des 27 indicateurs suivants ...

International collaboration: harnessing differences to meet common needs in improving quality of care

A growing number of countries worldwide are recognising a common need to build systemic capacity for safeguarding and improving quality of health care. Each country has a unique set of priorities and dynamics driving the speed and the substance of the quality agenda, constrained by the reality of the availability and distribution of resources. While acknowledging the considerable variation in context between countries, it is imperative to explore the role for, and potential of, cross-national collaboration to advance our common goals regarding improved performance in health care quality. Often the conventional basis for collaboration is a perception of similar need and/or convergent initiatives. As useful as such collaboration may be, building a partnership on common needs but different initiatives may be more useful. It could build on the complementarity of experience and expertise, as well as the commonalties. Divergent legacies and orientations may point to the richest areas for learning through cross-fertilisation to facilitate transfer of insights and expertise. One example of binational collaboration, building on both common challenges and different solutions, is the emerging repertoire of partnerships between the USA and UK in health care quality. These two countries, with stark differences in their health care systems, easily recognise their commonality of need as quality becomes a prominent focus of national health policy. Collaboration between the UK and the USA derives from the understanding that there are significant areas of convergence and divergence. In both these countries, as well as a growing number of others worldwide, the …