Research published in the Joint Commission Journal on Quality & Patient Safety tackles the question of what is a high-performing health system, now that we are so busy trying to measure, report on and reward the creation of such a system. (HPHS Article) The research starts by noting inconsistent and variable definitions of what is high-performance and conducts a literature search to identify as many definitions as possible. The articles reviewed were not limited to the United States, since theoretically a high-performing system should be pretty much the same around the world. 52 articles which attempted to create a comprehensive definition of high-performance were included in the analysis. Lack of consensus on defining, and subsequently measuring, performance may or may not be a big problem, but it would be nice if we are going to reward or penalize organizations to at least have some rigor behind what behavior we are striving toward.
Organizations were reviewed at several levels: some of the research focused on the national system, some on hospitals, others on medical groups or ACOs. Several common dimensions were identified in a definition of a high-performing system: quality; cost, access, equity, patient experience and patient safety. Most of the research reviewed focused on one or more of these attributes, with the most common pairing being quality and cost. Most of these articles appear to me to be what I would consider theoretical; they don’t necessarily link clear patient improvements in health and health behaviors with their definitions, although generally the attributes make sense. But only a minority of the articles surveyed actually listed specific metrics to determine, for example, that a system was high-performing on quality or access. Others just rely on pre-existing sets of measures, many of which have not been clearly shown to impact better patient health, better treatment outcomes or better health behaviors. The article performs a real service by pointing out the gap between our constant prattle about wanting a high-performing health system and the lack of a consistent and meaningful way of measuring that we have achieved that objective.