THE 3 FACES OF PERFORMANCE-MEASUREMENT - IMPROVEMENT, ACCOUNTABILITY AND RESEARCH

Background: In the current climate of public accountability, many clin icians have become uncomfortable with any efforts to create measuremen t systems. This is, unfortunate because measurements are absolutely es sential to efforts for improving the processes of medical care. In Min nesota, work has been conducted with clinicians on measurement pursued for accountability, improvement, and research. Measurement in the imp rovement process: There are at least three steps in process improvemen t where measurement is likely to be important: when identifying which problems, or opportunities for improvement, need attention; when the p rocess improvement team is obtaining baseline measurements; and after a new improved process ha's been implemented. Contrast with measuremen t for accountability: Data for accountability, which are data on outco mes or results, do not usually illuminate how the outcomes were achiev ed or how processes might be changed to improve them. The measures sel ected for accountability will be measures that matter to external part ies, for example, outcome data on complication rates or costs of care. Contrast with measurement for research: Although objectives and metho ds of measurement for research make it different from measurement for improvement in many respects, its familiarity to physicians-and its at tractiveness to them as scientists-poses a problem for measurement for improvement in health care. Measurement for research is typically too slow, too expensive, and too elaborate to be useful for improving pro cesses in single clinics or hospitals. Summary and conclusions: Experi ence in guideline implementation and measurement efforts has yielded l essons on how to understand the differences in purposes of measurement .