Response: Setting the Stage for Improvement and Accountability

Abstract

Deborah Garnick: Dr. McCorry provides a concise overview of several large, national efforts in performance measurement and quality improvement. He has done an excellent job of bringing together the work of the Washington Circle, Network for the Improvement of Addiction Treatment (NIATx), National Outcome Measures, and Clinical Trials Network. The article is a fine starting point for someone to get a sense of the landscape and to jump off, using the links and references he provides, to more detail about each of the projects. Daniel Kivlahan: I particularly like the image of the three-legged stool, emphasizing how interrelated these three major themes are— the content, the data and measurement features, and then the quality improvement efforts. That’s the broad context that makes a huge difference in how far a particular agency is likely to get with implementation. Each of the projects discussed in the paper provides a different spectrum of options for instituting quality and performance measurement and improvement. The NIATx system starts at the front door of the organization, so it can give a lot of clues about patient-level experiences and barriers to better outcomes that programs might overlook. The National Registry of Evidence-Based Programs and Practices becomes useful when clients have gotten through those early treatment hoops and are waiting for at least some initial intervention. Linda Bradshaw: Of Dr. McCorry’s tips on how to get started, I was impressed by the create-a-crisis concept: challenging your local boards and people in your agency to take a hard look at the wave of the very near future and start getting ready for it. That seems a very practical way to go about getting someone’s attention. Kivlahan: Another approach might be to ask the line staff what kind of information was on the last list or spreadsheet they saw. For example, staff members frequently get lists of chart deficiencies, things they haven’t documented appropriately. Reviewing these together would reinforce the commitment to measurement by reiterating the importance of the items on the list. The discussion might produce a consensus that you are tracking the right things, or it might lead to a shift to other, more productive measures.