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Volume 47, Number 4
July/August 2002

    Interview with Michael H. Covert, FACHE, president, Washington Hospital Center, Kyle Grazier
    JCAHO: Responding to Quality and Safety Imperatives, Alan E. Cudney and Opal Reinbold
    Radical Change: One Solution to the Nursing Shortage, Steven M. Barney
    • The Role of the Internet in Improving Healthcare Quality, Kathryn E. Kerwin
    • Recruitment, Retention, and Management of Generation X: A Focus on Nursing Professionals, Judy A. Cordeniz


    • Measuring Primary Care Practice Performance Within an Integrated Delivery System: A Case Study, Louis J. Stewart and David Greisler
    • Perceived Barriers to Medical-Error Reporting: An Exploratory Investigation, Claudia L. Uribe, Sharon B. Schweikhart, Dev S. Pathak, and Gail B. Marsh

Executive Summary
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

This article 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.

We conduct 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.

Our findings 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 organizational stakeholders.

Executive Summary
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.

Medical-error 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.

This study 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).

The strategies 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.