Organizational Approaches To Improving Quality

Legislation and regulation

The regulatory approach to quality is to define processes and boundaries, and impose consequences for not following them. The premise is that poor quality comes from poorly defined standards.

The overall approach to quality used by these groups is to:

• Improve quality in specific areas, such as access and physician competence
• Develop accreditation standards to define minimally expected performance/expectations
• Apply scientific knowledge to healthcare quality and communicate “best practices”

Major organizations using this approach include all the accrediting agencies (JCAHO, NCQA, URAC), licensing boards, and government regulatory agencies (CMS, FDA, State Public Health Authorities, Departments of Insurance).

Non-regulatory approaches

Other groups avoid the negative connotations of regulation, and use more positive approaches to encourage quality and safety. The overall approach taken by these groups is to:

• Utilize education, demonstration projects and research
• Provide public education
• Provide incentives to improve patient safety
• Establish world-wide standards
• Identify and discourage inappropriate medical practices

Major organizations of this type include IHI, IOM, AHRQ, NQF, and the Leapfrog Group.