cesses and outcomes of care important to patients and communities. Measurement should foster individual and shared accountability for health system performance. When no responsible agent can be identified, shared accountability by all agents within the health care system should be presumed, and responsible stewardship encouraged and induced. In many settings, this will require significant restructuring of how care is currently delivered.

Principle 9: A Learning System

A performance measurement system should be a learning system, continually evaluating its own performance and advancing knowledge regarding performance measurement. A national system for performance measurement and reporting should advance knowledge of (1) how environmental levers, such as purchasing, pay for performance, and quality oversight can best be used to motivate quality improvement; (2) the most effective strategies for redesigning care processes, including methods for transferring knowledge, implementing information technology, and forming effective care teams; and (3) the extent to which all quality efforts lead to improvements in the six quality aims.

Principle 10: Independent and Sustainable

A performance measurement and reporting system should be continually enhanced and financed in a way that ensures its independence and sustainability. This system should be dynamic and should evolve based on careful evaluation of its impact and advances in the science base. It should be adequately supported by both public- and private-sector stakeholders.


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IOM (Institute of Medicine). 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press.

IOM. 2003. Priority Areas for National Action: Transforming Health Care Quality. Adams K, Corrigan JM, eds. Washington, DC: The National Academies Press.

National Quality Forum. 2004. National Priorities for Healthcare Quality Measurement and Reporting. [Online]. Available: http://www.qualityforum.org/webprioritiespublic.pdf [accessed January 19, 2005].

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