As healthcare organizations strive to gain control over quality, they can expect the journey towards ‘high reliability’ to take them through various stages, with the pursuit of excellence and safety gradually becoming systematic, towards a culture obsessed with outcomes and safety – and the measurement of these factors.
Responsibility for quality will likely become less reliant on individuals and more on teams. Staff should learn to embrace standardized processes trading individual for collective autonomy, leading to improved outcomes and a sharp decline in harm rates.
Regulatory demands are expected to change significantly, as providers, payers, governments and commissioners acknowledge the need to converge internal and external measurements and reporting around the key outcomes that matter most to the patient.
These outcome measures should become increasingly internationally standardized – as guidelines increasingly are also. Quality audits will likely become the norm and adopt the same standards as financial assurance, to give regulators, contractors, patients and other stakeholders confidence that reports accurately reflect real performance. Likewise, certification should focus primarily on the safety of care, assuring error rates much lower than we are now used to.
The organizations studied in this paper are all making progress along the path to high reliability and have adopted some or all of the following actions:
Good clinical governance requires boards to pay at least as much attention to quality issues as is paid to financial issues, and to publicly account for outcomes in these two fields in the same way.
Industry best practices for quality reporting should therefore consist of a periodically and publicly issued report that contains information that is relevant for all the stakeholders:
Although there are no global standards for quality reporting in healthcare, global standards for giving assurance on non-financial reporting, such as quality data, do exist and are used in several countries where external audits and reporting on selected clinical data is required.