The quality of American healthcare is neither as good as generally believed nor as good as it could and should be given the vast resources we spend on it. In response to the now clearly identified quality problem, many improvement initiatives have been launched by accreditation bodies, business coalitions, government, medical specialty societies, professional associations and quality-improvement organizations. Indeed, in the past decade, a whole industry of healthcare quality improvement has been born.
These efforts are well meaning but uncoordinated, and an observer might describe them as bearing a striking resemblance to Brownian motion, the random movement of small particles in fluid. There is no question about the good intentions of the many efforts under way, but the disparate initiatives are too often unfocused and even duplicative. Notwithstanding a probable incremental improvement in healthcare quality as a result of these efforts, the myriad of quality-improvement activities has produced substantial angst, confusion and skepticism among already overworked doctors, nurses and healthcare managers.
As described in Jeff Tieman's Jan. 26 "Washington View" column (p. 30), there is a need for someone to orchestrate healthcare quality-improvement efforts in the U.S. The National Quality Forum was created to do just that. The NQF is doing much of what was advocated by several sources quoted in the column and is poised to do much more.
The idea of establishing a public-private partnership to standardize healthcare performance measurement and reporting and otherwise lead quality-improvement efforts was proposed by the Advisory Commission on Consumer Protection and Quality in the Healthcare Industry, which President Clinton started in 1998. Recognizing the nature of U.S. healthcare and cul-tural biases about government, the commission felt that this forum should be a private, not-for-profit organization governed by leaders from both the government and the private sectors. A subsequent planning committee, which convened under White House auspices, laid out the basics of governance and organizational structure for the forum, obtained startup funds and incorporated the organization in Washington in 1999 as a public benefit corporation.
As a voluntary standard-setting body, the NQF has a well-defined and transparent process for arriving at a consensus among healthcare's disparate stakeholders. This consensus development process is governed by the National Technology and Transfer Advancement Act of 1995 and other federal directives, which dictate that the process be open, clearly defined and have a balance of interests. This gives NQF-endorsed standards legal status.
In many ways, the NQF is an experiment in democracy by virtue of the equitable role of consumers, healthcare providers, purchasers and others in decision-making, and the significance of the public-private partnership through which alignment of interests can be achieved. Not surprisingly, this new approach to healthcare decision-making was not enthusiastically embraced by all initially. However, there is now a growing recognition of the strength and value of this new approach to balancing self-interest with the public good.
NQF members now include more than 200 healthcare consumer, provider, purchaser and other organizations. It has promulgated national voluntary consensus standards for safe practices in healthcare, serious reportable events and performance measures for acute hospital care, nursing homes, nursing care and diabetes. It has recommended a comprehensive framework for a national healthcare performance measurement and reporting system, as well as a more specific framework for hospital performance measurement and reporting. And it has convened important national forums on disparities in healthcare, information technology and quality, child healthcare quality, and the security of networked medical devices. Work on achieving consensus about national healthcare quality-improvement priorities is almost completed, and work is well under way on national consensus standards for cardiac surgery, cancer care, ambulatory care, home care, mammography performance indicators for consumers and a standardized patient-safety taxonomy. The leadership role of the NQF on a number of other issues is being explored.
With its broad-based and inclusive membership, public-private nature, open decision-making and consensus processes-as well as a lack of any interest other than promoting the public good-the NQF is in a unique position to lead the push toward better quality. It has already taken significant steps toward turning the cacophony of current quality-improvement initiatives into a symphony of beneficial change.
In spite of its success so far, the NQF continues to be challenged in its efforts to provide leadership. Chief among those challenges is the absence of unrestricted and stable funding that would allow it to pursue activities that clearly need to be done but that do not align with the priorities of funding sources. Likewise, some professional associations and other entities should cede some of their autonomy and work in a more collaborative manner with the NQF. And there is a need for purchasers and payers to use national consensus standards for performance assessment when such performance measures exist.
The need for healthcare quality improvement in the U.S. is well demonstrated, and we can't afford to continue to pursue disjointed and redundant quality initiatives. The NQF provides a pragmatic, efficient and now well-tested vehicle to move the quality-improvement movement forward. It is time for all interested parties to get aboard.
Kenneth Kizer is president and chief executive officer of the National Quality Forum, Washington.