With these challenges in mind, the Department of Medicine (DOM) at Brigham and Women's Hospital (BWH) sought to build a grassroots quality program that would fit within an academic medical center's (AMC's) tripartite mission of excellence in clinical care, research, and education. 10–13 Furthermore, physicians and other health care professionals often regard collection and reporting of quality measures to be a burden on time and financial resources.

Physicians may be skeptical of the clinical value of externally selected measures, consistent with a belief that public reporting of poorly designed quality measures can have a negative impact on care. 5–9 Too many external mandates may dilute the importance of each area selected for improvement, and yet, paradoxically, only address a limited patient population or a small part of a patient's care. 4ĭespite the push for higher-quality care, many hurdles to effective quality efforts remain. 2,3 The focus of improvement efforts often resides in three aspects of care delivery: organizational infrastructure, process of care, and clinical outcomes. government seeks to spur further improvements in quality as part of its health care reform efforts. 1 The drive to improve quality is shared by those within the profession, as well as patients and payers. Quality efforts in health care today demand increasingly comprehensive and rigorous approaches to measurement and improvement. The program's system-based focus encourages providers to develop solutions within the existing framework of clinic resources, primarily targeting work flows and processes, while minimizing large expenditures on additional staffing.

The program's largest challenges have been in capturing meaningful data from electronic systems. The subsequent production of meaningful, actionable data has been instrumental in building physician acceptance and in providing clinicians the opportunity to evaluate and monitor performance. The central quality team facilitates measurement and reporting while providers focus on patient care. Given the flexibility to define their own metrics according to their patients' needs, clinicians have selected measures related to prevention and wellness, which are often based on national standards. The quality program has engaged the department's physicians from the start. To meet these challenges, the Brigham and Women's Hospital Department of Medicine created a grassroots quality program guided by four main principles: improvement is led by frontline clinicians who select measures important to their patients, performance measurement is automated and accurate, appropriate resources are provided, and interventions are system based and without financial incentives for individual providers. Obstacles include selecting measures with clinical value, building physician acceptance, establishing routine and efficient measurement, and resolving competing clinical demands and work flow impediments. Improvement efforts led by patients, payers, regulators, or health care providers face many barriers.

Quality improvement in health care today requires a comprehensive approach. Supplemental digital content for this article is available at. Kachalia is medical director, Quality and Safety, Brigham and Women's Hospital, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts.Ĭorrespondence should be addressed to Dr. Loscalzo is chair and physician-in-chief, Department of Medicine, Brigham and Women's Hospital, and professor of medicine, Harvard Medical School, Boston, Massachusetts.ĭr. Turchin is senior medical informatician, Clinical Informatics Research and Development, Partners HealthCare, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts.ĭr. Coblyn is vice chair, Integrated Clinical Services, Department of Medicine, Brigham and Women's Hospital, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts.ĭr. Szent-Gyorgyi is quality program manager, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.ĭr.

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