Using Accountability to
Improve Quality
Shoshanna Sofaer, Dr.P.H.
School of Public Affairs
Baruch College
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
1
Overview
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Who is accountability for what?
Who needs to act to improve quality?
Needed new directions in measurement
Needed improvements in public reports
What are we encouraging through pay for
performance?
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
2
Who is accountable?
• Accountability and control
– The provider perspective
– The consumer/patient perspective
• If no one is totally in control of quality,
does that mean no one can be held
accountable for it?
• Moving toward a model of shared
accountability for quality
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
3
Who can/should act on quality?
• Major implication is that all parties have a role in
improving quality
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Purchasers/consumers through choices
Purchasers through incentives
Regulators through higher standards
Advocates through demands for improvement
Delivery system through structural changes,
incentives and process improvements
– Individual providers through embracing changes and
referral patterns
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
4
New directions in measurement
• In measurement, perfect cannot be the
enemy of the good, but
– We need measures that move beyond the
silos of the current delivery system structure
– We need measures that provide insight into
the overall performance of organizations and
practices
– We need measures that discriminate and that
resonate with consumers/patients
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
5
Needed improvement in public
reports
• Use the evidence! If you don’t use the
evidence, don’t be surprised if no one
uses the reports
• Learn how to integrate different kinds of
measures into a single report
• Don’t just put reports out there, promote
them so people actually know they are
there, access them and then, use them
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
6
Pay for performance
• Money is obviously a powerful incentive
• We have to be careful what we encourage
through P4P – okay performance or
unusually wonderful performance
• We cannot afford to pay more for high
quality performance unless we pay less for
substandard performance (especially
around safety)
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
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Final thought
• Choice and improvement
– We think of choice as “driving” improvement
– However, if high performance options are not
available, choice cannot work
– Improvements in quality, therefore, can also
make choice a more meaningful strategy
– Both must be pursued together
February 12, 2007
Shoshanna Sofaer, Dr.P.H.
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