audit-and-feedback mechanisms be conducted instead of the current intervention group versus control group comparisons. It was also suggested that a process of implementing and evaluating effective quality improvement strategies be developed so that the implementing organization would have more knowledge of the intervention before attempting to spread to other organizations.

Current efforts around variations in health care were noted as attempting to narrow disparities. Instead, variations should be studied. Partnerships should form to help study why variations exist, help identify characteristics of variations, and help study the components of variations.

Addressing the more technical side of interventions, a few attendees called for a stronger technical infrastructure to support quality improvement efforts. It was noted that measures of health care must be standardized. Currently measures are defined in a variety of ways (e.g., some measures of breast cancer care include women aged 40–60, while others include women aged 35–55), making meta-analyses difficult to conduct because data cannot easily be aggregated, much like comparing apples to oranges. Others noted that a greater emphasis needs to be placed on developing outcomes measures that could be used to drive improvement efforts. Patient satisfaction measures also need to be developed and more widely incorporated in improvement efforts.

Another concern is the lack of comprehensive databases to use to make decisions about interventions. Such a tool could be very useful in sharing best strategies and lessons learned.


Another major focus is the need for knowledge about organizational change and cultural change in health care. The role of leadership is critical, but it is unclear how to engage top levels of leadership in quality improvement efforts. One response was to provide top leadership with motivation for incremental change. Implementing one or two small, moderately successful interventions could be the basis for widespread change. However, change does not occur only from the top, but must be integrated from levels throughout the entire organization. For example, the receptionist, a patient’s first point of contact, could be a key leader for change and should be as involved as the office manager.

Strategies for approaching change should also be considered. For example, finding ways to improve average providers may be more of a motivating factor for change than improving top perform-

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