Measuring What Matters in Health Care

As nurses, we strive to bring our own special blend of compassion and skill to our patients, to help them heal. But how do we know that we’re providing the best possible care, or that our patients will continue to have a positive experience within the health care systems after they’re discharged?

No one person or profession can see across the entire, complex health care continuum to make sure the end result is overwhelmingly positive. And that’s why we use performance measures to light the way, showing us where our efforts are making a difference, and where they’re breaking down or potentially causing harm. According to the National Quality Forum (NQF), there are three compelling reasons to use performance measures in health care:

  • To drive improvement in standards of care and patient outcomes.
  • To guide consumers in making personal choices and advocating for good care.
  • To influence payment guidelines, whether it’s rewarding providers with a bonus for meeting performance goals, or instituting non-payment for a preventable adverse event.

The NQF: Consumer-focused public reporting of performance measures

We recently explained how databases are being used to improve standards of nursing care. The National Database of Nursing Quality IndicatorsTM (NDNQI®) is perhaps the biggest player in collecting nursing-specific data – it is well known for demonstrating that understaffing in nursing units is linked to higher rates of adverse patient outcomes.

But there’s another big player that you should know about when it comes to general performance measures in health care – it’s the National Quality Forum.

The NQF is unique in that it doesn’t just represent the medical establishment. Instead, it was established to build a consensus among consumers, payers, and providers about standardized indicators that can be used to measure and publicly report on health care quality. This increased collaboration has the potential to drive better health for all Americans – and there are a couple of simple ways that you can contribute your expertise, as a nurse and as a consumer of health care.

How the process works – and how you can become involved

The NQF has adopted a three-year schedule to evaluate performance measures in 22 areas, such as cardiology, neurology, infectious disease, etc. For each Consensus Development Project, the NQF follows a careful, nine-step process that has been developed to ensure transparency, public input, and discussion among a broad spectrum of groups that each represents a different part of the health care system. A steering committee guides the project along through all the steps. Once the committee has reached a consensus of standards, the hope is that health care organizations will:

  • voluntarily adopt the recommended best practices, and
  • publicly report on the recommended performance measures.

Anyone can enroll at and set up a personal dashboard that allows you to easily follow projects of personal or professional interest. So let’s say that you’re a nurse in a dialysis center. You log in to the NQF website and see on your dashboard that a current project is evaluating the quality of care for renal-related diseases. This is an area in which you have some expertise – and some strong opinions. If the project is in its early stages, you might know of someone who would be an ideal candidate to serve on the steering committee – or you might even want to nominate yourself. Once the public discussion has been opened, you can share your own ideas about current care standards for dialysis patients. And when the project is completed, if you have an objection to a measure that’s been approved for endorsement, you have the opportunity to ask for an appeal.

An NQF brochure titled The ABCs of Measurement makes a strong plea for the public to participate in its projects. Here’s an excerpt:

Public input plays an important role in NQF’s decisions about measure endorsement. One example comes from debate about endorsing a measure for the proportion of patients who achieve 20/40 vision through cataract surgery. The committee was leaning against endorsement, but public comments suggested greater variability in outcomes among physicians and patient groups than research was showing. As a result, NQF endorsed the measure, which will help us learn more about outcomes of this surgery, especially in non-academic and community hospitals. The answers have high stakes since more than half of all Americans have the procedure by age 80.

It’s something to think about, isn’t it?

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