We Can Trust without Data, But We Are Accountable Only through Measurement

Abstract

Traditional expectations about healthcare continue to be challenged by the umbrella concerns about accountability and trust. The core of this challenge is two-fold: healthcare providers have seen the absolute trust placed into their intentions and practices erode through the quantification of quality and safety of care, and, the recipients of care have been empowered with timely and specific data to demand accountability rather than unquestionably trust providers. The purpose of this chapter is to review the key dimensions of the operationalization of performance measurement and the translation of its findings to statements about quality and safety of care. The past four decades have seen the continuous discovery and refining of analytical tools to quantify what once was taken for granted: that patients always receive the best care possible. These tools have uncovered the probabilistic nature of medicine and the resulting nature of the relationships outcomes have to processes. Hence the expectations of patients, payers of care and policy makers require being continuously modified to reflect the limitations of medicine and healthcare. The education of various audiences as to what the measures mean not only is a necessary requisite for sound project design but also will determine how the accountability model is shaped in each environment based on the generic measurement tools results, local traditions of care and caring, and expectations about outcomes.