ABSTRACT
BACKGROUND: Public accountability is the watchword of the 1990s. A chief executive officer (CEO) has many "publics," internal and external, demanding accountability. Most have different agendas. Although much rhetoric is focused on quality, access and cost seem to be the real interests of most constituents. ISSUES: What tools help the CEO respond effectively in this environment? How useful will outcome measures be to the CEO in the current competitive environment? If outcome measures are not useful in gaining market share, do they have other value? What other means are available for the CEO to learn about the quality of care in their institution? In addition to quality, what other issues should be of primary concern? CONCLUSION: Quality care, as measured by outcomes and other means, is a necessary but not sufficient condition for success in the current environment. Market share is still largely determined on the basis of price. A basic commitment to quality is still paramount. The CEO also needs to focus on value, defined as quality/cost x efficacy (appropriateness) in dealing with constituent groups. Other components of success include developing a clear vision for the institution and finding appropriate partners. Public accountability presents a challenge and an opportunity for CEOs to demonstrate commitment to meeting the hospital's obligations.
