From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System

Published:February 16, 2017DOI:https://doi.org/10.1016/j.jcjq.2017.01.001

      Background

      As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety.

      Four Key Components of a Financial Reporting Structure

      The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting.

      Conclusion

      If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality.
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      Biography

      J. Matthew Austin, PhD, is Assistant Professor, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, and Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore.

      Biography

      Renee Demski, MSW, MBA, is Vice President for Quality, Johns Hopkins Health System, Baltimore, and Armstrong Institute for Patient Safety and Quality.

      Biography

      Tiffany Callender, MSW, PMP, formerly Quality and Innovation Project Manager, Armstrong Institute for Patient Safety and Quality, is Senior Program Officer, Horizon Foundation, Columbia, MD.

      Biography

      K.H. Ken Lee, DrPH, MHS, is Director, Value Analytics, Armstrong Institute for Patient Safety and Quality.

      Biography

      Ann Hoffman, MBA, is Director, Clinical Decision Support, Johns Hopkins Health System.

      Biography

      Lisa Allen, PhD, is Chief Patient Experience Officer, Johns Hopkins Medicine.

      Biography

      Deborah A. Radke, CPA, is Senior Director, Internal Audits, Johns Hopkins Medicine and Johns Hopkins University.

      Biography

      Yungjin Kim, CPA, is Advanced Senior Internal Auditor, Johns Hopkins Medicine and Johns Hopkins University.

      Biography

      Ronald J. Werthman, MBA, is Senior Vice President and Chief Financial Officer, Johns Hopkins Medicine, and Chief Financial Officer, Johns Hopkins University School of Medicine.

      Biography

      Ronald R. Peterson, MHA, is President, The Johns Hopkins Hospital and Johns Hopkins Health System, and Executive Vice President, Johns Hopkins Medicine.

      Biography

      Peter J. Pronovost, MD, PhD, FCCM, is Professor and Senior Vice President of Patient Safety and Quality, Johns Hopkins Medicine; Director, Armstrong Institute for Patient Safety and Quality; Professor, Department of Anesthesiology and Critical Care Medicine, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, and School of Nursing, Johns Hopkins University; and Member, Editorial Advisory Board, The Joint Commission Journal on Quality and Patient Safety.