Measurement is a critical tool for monitoring progress and driving improvement in health care. However, without meaningful coordination and management—particularly when public reporting is required—the effectiveness of measurement activities is limited and the diversion of effort from other activities can be detrimental to an organization. Often, the metrics used in quality reporting are derived from billing and administrative systems. Concentrating on improving these metrics may siphon energy from more meaningful or clinically relevant improvements. Too many measures can blur the focus on an institution’s priority issues while crowding out resources in terms of time, staffing, and money needed for innovation and improvement. Overall costs are increased. Also, metrics may be influenced by socioeconomic factors that are inadequately measured, thereby disproportionately penalizing providers (both hospitals and clinicians) that care for low-income patients.
Hospitals and provider groups are increasingly being asked to report on process and outcome metrics in attempts to signify the quality of the care provided to patients and to provide transparency to the public. Advocates of public reporting believe it helps patients choose the best place for their care. Additionally, transparency of quality metrics within a health care organization may guide improvement efforts and lead to positive behavior changes of health care personnel. While there is no doubt that metric reporting has focused positive attention on the quality of health care, the costs and benefits associated with these activities are poorly understood.