Louis J. Stewart, Ph.D., C.P.A., assistant professor, Robert F. Wagner
School of Public Service, New York University, and David Greisler, D.P.A.,
assistant professor, York College, York, Pennsylvania
examines the use of an integrated performance measurement system to plan
and control primary care service delivery within an integrated delivery
system. We review a growing set of literature that focuses on the development
and implementation of management reporting systems among healthcare providers.
Our study extends the existing literature by examining the use of performance
information generated by an integrated performance measurement system
within a healthcare organization.
our examination through a case study of the WMG Primary Care Medicine
Group, the primary care medical group practice of WellSpan Health System.
WellSpan Health System is an integrated delivery system that serves south
central Pennsylvania and northern Maryland. Our study examines the linkage
between WellSpan Health's strategic objectives and its primary care medicine
group's integrated performance measurement system. The conceptual design
of this integrated performance measurement system combines financial metrics
with practice management and clinical operating metrics to provide a more
complete picture of medical group performance.
demonstrate that WellSpan Health was able to achieve superior financial
results despite a weak linkage between its integrated performance measurement
system and its strategic objectives. WellSpan Health achieved this objective
for its primary care medicine group by linking clinical performance information
to physician compensation and reporting practice management performance
through the use of statistical process charts. They found that the combined
mechanisms of integrated performance measurement and statistical process
control charts improved organizational learning and communications between
Claudia L. Uribe, M.D., M.H.A., chief of quality, COLMENA Salud, Bogata,
Columbia; Sharon B. Schweikhart, Ph.D., associate professor, Health Services
Management and Policy Division, The Ohio State University, Columbus; Dev
S. Pathak, D.B.A., director, Center for Health Outcomes, Policy, and Evaluation
Studies; professor, Health Services Management and Policy; and Merrell
Dow Professor, The Ohio State University, Health Services Management and
Policy Division, Columbus; and Gail B. Marsh, administrator, Quality and
Performance, The Ohio State University Health System, Columbus.
reporting is an essential component for patient safety enhancement. Unfortunately,
medical errors are largely underreported across healthcare institutions.
This problem can be attributed to different factors and barriers present
at organizational and individual levels that ultimately prevent individuals
from generating the report.
explored the factors that affect medical-error reporting among physicians
and nurses at a large academic medical center located in the midwest United
States. A nominal group session was conducted to identify the most relevant
factors that act as barriers for error reporting. These factors were then
used to design a questionnaire that explored the likelihood of the factors
to act as barriers and their likelihood to be modified. Using these two
parameters, the results were analyzed and combined into a Factor Relevance
Matrix. The matrix identifies the factors for which immediate actions
should be undertaken to improve medical-error reporting (immediate action
factors). It also identifies factors that require long-term strategies
(long-term strategy factors) as well as factors that the organization
should be aware of but that are of lower priority (awareness factors).
outlined in this study may assist healthcare organizations in improving
medical-error reporting, as part of the efforts toward patient-safety
enhancement. Although factors affecting medical-error reporting may vary
between different organizations, the process used in identifying the factors
and the Factor Relevance Matrix developed in this study are easily adaptable
to any organizational setting.