The Institute for Healthcare Improvement identified several pitfalls and promising practices drawn from the American healthcare sector's experimentation with quality-improvement methods and performance management:
  • Avoid systems myopia: Healthcare has long been guilty of myopia, focusing on improvement in hospitals and specialty areas, while failing to understand the larger societal factors responsible for unequal outcomes and skyrocketing costs;
  • Start with the customer: The healthcare system prioritizes the financial goals and operational needs of care purchasers, providers and payers, which results in fragmented systems that are both disrespectful of patients’ time and damaging to their health;
  • Track rate of learning: While many systems invest in the trappings of quality improvement, the most successful study the rate at which they trial innovations and learn what works;
  • Emphasize adaptation, not fidelity: Much of the work of improvement in healthcare involves taking ideas and innovations already established in the evidence base and adapting them to different care settings;
  • Design measurement systems for the front line first: Measurement systems too often serve the needs of regulators, administrators, academics and other third parties who use data for research and inspection;
  • Embrace nuance in evaluation: Thoughtful researchers have come to understand there are many approaches to learning and evaluation, and each is appropriate at different times;
  • Live in the field: The most successful quality-improvement efforts use data as a prompt to visit communities, hospital units and other care settings;
  • Understand the psychology of change: Healthcare has often focused on more-technical aspects of organizational change, but technical work often fails to connect with the reasons people are called to their professions;
  • Approach payment incentives with caution: Possible reasons for the failure of pay-for-performance programs include the fact they make faulty comparisons between dissimilar organizations, induce groups to misreport their performance and belittle and discourage providers; and
  • Address inequity proactively: All improvement efforts must proactively address inequity or risk deepening it, exacerbating gaps on the very dimensions they seek to improve.

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