• Use laws, accreditation practices, payment mechanisms, and the media to foster the safety and quality of medication use.

Process improvement is primarily the responsibility of providers who must redesign processes at the microsystem level (see Chapter 5). There are, however, key roles in process improvement for legislators, regulators, accreditors, payers, and patient safety organizations.

There are two separate but linked pathways to quality improvement using the measurement of health care performance (see Figure 8-1) (Berwick et al., 2003). Pathway 1 uses performance measurement for accountability purposes—allowing patients, accreditors, and regulators to know how well a particular unit is performing—and for selection purposes—helping patients, referring clinicians, and purchasers decide which providers to use for the services they wish to purchase. Pathway 2 uses performance measurement to design and implement new processes for delivering higher-quality care. The two pathways are linked through the motivation for process

FIGURE 8-1 Two pathways to quality improvement.

SOURCE: Berwick et al., 2003.