The ORYX initiative: goals and potential application to physician quality improvement efforts.

Demands for public accountability in health care are more widespread today than at any time in the past. A number of national performance measurement efforts, including the ORYX initiative of the Joint Commission on Accreditation of Healthcare Organizations, represent an effort to provide stakeholders with the data they need to make judgments about the quality of health care provided to the public. The underlying premise of performance measurement is that organizations and clinicians can only improve what they can measure. Clinicians are the natural leaders in effecting broad-based change because of their direct influence on patient care and the respect they command in the health care environment. As performance measurement initiatives evolve, the ability of health care organizations to implement empirically based, structured improvement will increase and become commonplace.

Data-driven performance improvement in health care: the Joint Commission's Indicator Measurement System (IMSystem).

BACKGROUND: Since 1986, the Joint Commission has worked to create an evaluation system that would remain standards based but would accent an organization's performance as well as its capability to provide care. One component is the Indicator Measurement System (IMSystem), which involves continuous data collection and periodic feedback about specific performance measures, or indicators. An indicator is a quantitative measure of an aspect of patient care. It is not a direct measure of quality; rather it is a screen or flag which indicates areas for more detailed analysis. METHODOLOGY: Sets of indicators, each set related to specific important health care functions such as perioperative care, are established by expert task forces and are then subject to two phases of testing. Alpha testing addresses face validity and feasibility of data collection and may result in indicator revision. In the beta phase, a large group of organizations test the indicators for validity, reliability, and usefulness in improving performance. OPERATIONAL ISSUES: In 1994, the IMSystem will contain ten indicators and participation by hospitals will be voluntary. Once the value of these data in the accreditation process has been demonstrated--possibly as early as 1996--participation will become an integral component of accreditation. Hospitals will transmit indicator data to the Joint Commission but no patient or physician identifiers will leave the hospital. The system will provide organizations with information they can use to monitor and improve their performance, while helping meet external needs for performance measurement.