Overview*

The Institute of Medicine (IOM) convened the workshop “Creating a Business Case for Quality Improvement and Quality Improvement Research” on October 15, 2007, in Washington, DC, to develop a better understanding of the economic and business disciplines that encourage sustained efforts to improve the quality of health care.

Throughout the country, institutional reluctance to invest in quality improvement and documentation of outcomes of quality improvement interventions remains a barrier to moving ahead, said Thomas Boat, co-chair of the Forum on the Science of Health Care Quality Improvement and Implementation. This reluctance stems from limited resources and, more importantly, competing priorities as to how these resources are spent within health care. For example, priorities tend to be placed on creating highly visible technology-driven programs, with less emphasis on meeting the needs and expectations of patients. Articulating a business case1 is

*

The planning committee’s role was limited to planning the workshop. The workshop summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop.

1

The following is a generally accepted definition of the business case but was not discussed or adopted during the workshop or by the planning committee. “A business case for a health care improvement intervention exists if the entity that invests in the intervention realizes a financial return on its investment in a reasonable time



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Overview* T he Institute of Medicine (IOM) convened the workshop “Cre- ating a Business Case for Quality Improvement and Quality Improvement Research” on October 15, 2007, in Washington, DC, to develop a better understanding of the economic and business disciplines that encourage sustained efforts to improve the quality of health care. Throughout the country, institutional reluctance to invest in quality improvement and documentation of outcomes of quality improvement interventions remains a barrier to moving ahead, said Thomas Boat, co-chair of the Forum on the Science of Health Care Quality Improvement and Implementation. This reluctance stems from limited resources and, more importantly, competing priorities as to how these resources are spent within health care. For example, priorities tend to be placed on creating highly visible technology-driven programs, with less emphasis on meeting the needs and expectations of patients. Articulating a business case1 is *The planning committee’s role was limited to planning the workshop. The work- shop summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. 1The following is a generally accepted definition of the business case but was not discussed or adopted during the workshop or by the planning committee. “A busi- ness case for a health care improvement intervention exists if the entity that invests in the intervention realizes a financial return on its investment in a reasonable time 

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 CREATING A BUSINESS CASE FOR QIR at the crux of the issue of how rapidly quality improvement and quality improvement research will advance, Boat said. The United States health care system is currently being threat- ened because it is not performing optimally, said Scott Hamlin, leader of the planning committee for the workshop. In every other industry, quality has been recognized as a necessity for value. We must understand what it is about health care that causes skepticism about whether the health care market can recognize quality and the rewards it brings so that we can capitalize on opportunities to strengthen the health care system. During this workshop, experts were asked to discuss the business case from the perspectives of those actually making the business case, policy makers, and researchers. The planning committee’s statement of task for developing the workshop agenda was “to provide the forum with insight into the economic, public policy, and business disciplines that create a sustainable value proposition for aggressively pursuing quality improvement in the health care system and thereby stimulating meaningful research in this field.” In summary, speakers indicated that a business case for qual- ity improvement can indeed be made. Many examples of business cases from a variety of settings were provided, while recognizing that robust research is at the core of the business case for quality improvement. A strong research base and data depicting the impact of quality improvement are necessary to create a business case for quality improvement. Throughout the workshop, common themes emerged. Making the right thing to do through systems change and leadership were recognized as necessary to improve quality of care delivery. Data and data transparency are also important for making health care more patient-centric. Speakers addressed funding as a key component of quality improvement and research on quality improvement due to the need to support the incorporation of health care innovations into practice. During the workshop, it was also noted that training must be enhanced to make research on quality improvement more robust. Finally, speakers discussed how the quality improvement and research communities must become better communicators and frame, using a reasonable rate of discounting. This may be realized as bankable dol- lars (profit), a reduction in losses for a given program or population, or avoided costs. In addition, a business case may exist if the investing entity believes that a positive indirect effect on organizational function and sustainability will accrue within a rea- sonable time frame” (Leatherman et al., 2003).

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 OVERVIEW include chief executive officers and chief financial officers, as well as patients and their families, in the ongoing dialogue to improve health care. The following chapters describe and summarize workshop pre- sentations and discussions. Therefore, the content is limited to the views presented and discussed during the workshop itself and is not intended to be a comprehensive assessment of the business case for health care quality improvement. The broader scope of issues per- taining to this subject area is recognized but could not be addressed in this summary. Appendix A is the workshop agenda, and Appen- dix B lists workshop participants. The forum is used by the IOM to convene representatives from academia, government, and industry. In bringing together this broad group of stakeholders with diverse views, the forum provides a neutral setting where issues related to improving the science sup- porting health care quality improvement and implementation can be discussed. Through their discussions, forum members attain a better understanding of what the needs are and begin crossing the communication barriers that prevent advances in the field.

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