BMJ  2007;335:971-973 (10 November), doi:10.1136/bmj.39358.498889.94

Analysis

Measuring quality through performance

Making performance indicators work: experiences of US Veterans Health Administration

¹ Center for Practice Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170, USA, ² Veterans Health Administration, Washington, DC 20420, USA

Eve Kerr and Barbara Fleming explain how measuring performance helped transform a failing healthcare system

Many healthcare organisations are having to confront the challenge of how to provide high quality care within a fixed (or sometimes shrinking) budget.¹ The Veterans Health Administration, which provides care for over 5 million veterans within the largest integrated healthcare system in the United States, faced this problem in the early 1990s, when it was struggling to overcome a reputation for providing inferior and inefficient health care. In 1995 it began a programme to simultaneously improve the organisation and quality of its care, with performance monitoring having a key role.^{2 3} Within 10 years, it was lauded as providing the best care in the US.⁴

The turnaround shows the value of monitoring performance and providing appropriate incentives to improve care. We explain how the organisation brought about the changes and look at some of the remaining challenges.

The administration made several organisational changes as a foundation for the quality improvements.^{3 5} Firstly, . . . [Full text of this article]

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