Measuring Health Care

Yosef D. Dlugacz, Ph.D., is senior vice president, Quality Management, North Shore—Long Island Jewish Health System, Great Neck, New York. He is the author of The Quality Handbook for Health Care Organizations: A Manager's Guide to Tools and Programs (Jossey-Bass). He has taught health care professionals both nationally and internationally, most recently in Italy, Brazil, and Sweden; he is a Visiting Professor at the University of Beijing. Dr. Dlugacz is also Dean of Quality for the Center for Learning and Innovation at the Health System and Director of the Julienne and Abraham Krasnoff Center for Advanced Studies in Quality.

• Figures and Tables. Preface.The Author.Introduction.1 Overview: What Measures Measure.Measures and the Medical Staff.Measures and Patients.Measures and Health Care Leaders.Measures and Money.Measures and Evaluating Care.Summary.Things to Think About.2 Fundamentals of Data.Quality and Finance: A Perfect Fit.Quality and Accountability.Let the Walls Come Tumbling Down.Finding Answers.Objectifying the Delivery of Care.Case Example: Cardiac Mortality.Case Example: Intensive Care Units.Defining Goals.Nothing New Under the Sun.Case Example: Falls.Communicating Information from Quality Measures.Leadership Defines the Level of Quality.Finding Questions.Summary.Things to Think About.3 Using Data to Improve Organizational Processes.Satisfying the Demanding Consumer.Offering Value.Showing the Numbers.Measures Are Good Business.Managing with Measures.The Value of Measures.Measures and Organizational Processes.Case Example: Nutrition.Case Example: Housekeeping.Monitoring Performance.Measures Promote Knowledge.Lack of Measures Leads to Poor Resource Management.Measures and Evaluating Services.Summary.Things to Think About.4 What to Measure—and Why.Leadership Determines What to Measure.Measures Define Quality Care.Measures Inform Financial Decisions.Measures and Purchasing Decisions.Measures and Patient Safety.Quality Methodology for Performance Improvement.Developing a Performance Improvement Plan.Case Example: Plan Do Check Act for Bariatric Surgery.Monitoring Variation from the Standard.Case Example: Moving Between Levels of Care.Understanding Patient Flow.Summary.Things to Think About.5 Promoting Accountability Through Measurements.Measures and Organizational Goals.Justifying Expenses.Case Example: Self-Extubations.Getting the Doctors on Board.Case Example: Wrong-Site Surgery.Analyzing Errors.Changing the Culture.Asking Questions.Evaluating Information and Communicating Results.Summary.Things to Think About.6 The Rationale for External Drivers of Quality.The Government Takes the Lead.Monitoring Quality for Changed Practices.The Media Carry the Message.Public Pressure Forces Change.Quality and Community Relations.Truth or Consequences.Quality Data Force Change.Case Example: Coronary Artery Bypass Graft.Make the Regulations Work for You.Summary.Things to Think About.7 Integrating Data for Operational Success.Different Data Tell Different Stories About Care.Working with Administrative Data.Working with Primary Data.Case Example: Stroke.Operational Decisions and Quality Data.Quality and Risk.Case Example: FMEA and Blood Transfusions.Communicating Quality Data.Case Example: Decubiti.Measures Tell the Truth.Summary.Things to Think About.8 Internal Drivers of Quality.Using Guidelines to Drive Quality.Ensuring That the Standard of Care Is Met.CareMaps Promote Standardized Care.Variance Data Help Drive Quality.Dealing with Resistance to CareMaps.Implementing Guidelines to Drive Quality Care.Everyone Benefits from CareMaps.Documenting the Delivery of Care.Case Example: Detoxification Guidelines.Summary.Things to Think About.9 Using Data for Performance Improvement.Aggregated Data Offer a Different Perspective.Case Example: Using Quality Methods to Ensure Consistency of Care.Case Example: Increasing Access to Care.Case Example: Improving Sterilization Across the System.Collaboration Works.Summary.Things to Think About.Conclusion.Bibliography.Index.