For example, consumers want to know the chances of developing complications or dying during a procedure or admission. Data transparency is critical for consumers to make informed choices about their care. Healthcare performance data are readily available to the public via national websites such as Hospital Compare.5


A


healthcare organization must understand how to demonstrate its outcomes and performance results. Some reasons for measuring performance relate to identifying improvements in performance, pinpointing which changes caused improvement and which changes didn’t make a difference, and having the ability to use evidence in decision making and the establishment of baselines for measurement.1


Types of performance measures Numerous performance measures have been developed and tested. The National Quality Measures Clearinghouse has a “domain framework” for measurement categories. Two major categories of measurement are used: 1) measures that relate to healthcare delivery and 2) measures that relate to popula- tion health (this article focuses on the measures that relate to healthcare delivery).6 Within each category are “domains of measurement.” These


measurements assess the clinical performance of nurses, phy- sicians and other clinicians; the healthcare organization as a whole; or, in some instances, the healthcare insurance plans and enrollees.6


Measures relating to healthcare delivery: Domains of measurement Quality measures such as “clinical quality measures” relate to the processes of care connected to a patient. Clinical quality measures are evidence based with an outcome focus.6


The per-


centage of patients with ventilator-associated pneumonia on an established prevention protocol or the number of patients with chest pain or stroke who receive fibrinolytic therapy (clot busters) within 30 minutes of hospital arrival are examples of clinical quality measures.7 Access measures seek evidence that access to healthcare is


timely and appropriate for patients using the services. Evidence shows an association exists between access and patient care outcomes or satisfaction with care received.6


An example of this


measure would include the number of patients with conges- tive heart failure readmitted 30 days post-discharge who had a follow-up appointment with their physician after discharge from the hospital or the access of specialized healthcare in rural service areas.7 Outcome measures are usually risk adjusted and evidence


supported. They measure the impact of clinical interventions on patient outcomes.6


Examples are hospital sternalwound infections


post-open-heart surgery with risk adjusted for age and physical condition among acute care patients per 1,000 discharges or the percent of cardiac surgery patients with controlled 6 a.m. postoperative serum glucose.4 Structure measures are evidence based and supported by


an association between the measure and any one of the clinical quality measure domains. The focus is on individual clinicians or the organization as a whole.6


44 NURSE.com/Careers • 2016 For example: Does the organization


use a computerized barcode scanning system for drug retrieval to reduce medication errors? Patient experience measures are based on patients’ perception


of treatment received and of their ability to participate in their own healthcare processes. Often these data are gathered from patient satisfaction surveys.6 with nursing responsiveness.


An example is patient satisfaction


Related healthcare delivery measures Measures that are not quality related are still important. These measures are not evidence based. User-enrollee health state is a quality measure concerning


those who either pay for an insurance plan (employers) or use clinical services provided (patients).6


Examples would be prev-


alence of CHF among health plan enrollees or the prevalence of lymphoma in patients insured in a company that processes chemicals known to cause lymphomas. Management measures relate to actions that are important to


healthcare, such as oversight of personnelwho deliver services but who are not part of the direct patient care delivery system.6


An


example would be whether an organization protects confidential information or drugs tests their employees. User of services refers to the encounters, tests and interventions the patient uses.3


a patient.6


An example would be the percentage of patients


who used outpatient services during the last year. Costs are the monetary or resource units used in caring for Examples would be the hospital costs for providing


outpatient clinic care or the cost that a hospital incurs when performing heart cauterizations. Clinical efficiency measures are measures that assess the


efficiency of resources used in providing care. These measures also include a comparison of known efficient processes of care being measured against currently implemented processes of care. Examples would be the incidence of failure-to-rescue episodes with a lowerRN-to-patient ratio or the incidence of patient falls related to staffing ratios for a unit.6


Setting goals Accountability for performance has become increasingly im- portant in healthcare, making goal setting more important than ever. An organization has an operational and financial need to understand the drivers behind its performance and demonstrate the results of its work. One healthcare research group found that operating margins in healthcare dropped to only 2.2% in 2011. It is projected that the operating margin in healthcare will drop to a negative 16.8% by 2021.7 In addition to the negative financial impact projected for the


healthcare industry, the government withholds payment for poor quality of care provided to its Medicare beneficiaries. Initially the government withheld 1% of total payment in 2014, but that will increase to a maximum of 2% by 2017. If an organization does not keep improving, it will sacrificemoney needed to care for patients and grow. To put this in perspective, if an organi- zation has total revenues of $48 million per year forMedicare patients, it stands to forfeit $960,000 by 2017 if it does not demonstrate quality care. An organization needs to establish the right methodologies to meet the needs of its patients. It requires


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