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Consumers' Priorities for Hospital Quality Improvement and Implications for Public Reporting

Marjorie Ginsburg and Kathy Glasmire, Center for Healthcare Decisions

In hospital quality, what do consumers want? This report reviews their perceptions of clinical effectiveness, patient safety, and efficiency, and whether consumers have a role in driving improvement.

What are consumers' priorities in terms of hospital quality, and does the public have a role in driving quality improvement efforts?

Since 2007, performance data from California hospitals have been publicly available on a website under the direction of a multi-stakeholder collaborative, the California Hospital Assessment and Reporting Taskforce (CHART). To help CHART leaders evaluate the usefulness of its work to consumers, the Center for Healthcare Decisions studied consumer perceptions of four Institute of Medicine quality domains: clinical effectiveness, patient safety, responsiveness to patients, and efficiency. The qualitative research involved a series of discussions with diverse groups of consumers throughout California.

The research described in this report is intended to help hospitals set priorities for corrective action and to provide new insights for those involved in public reporting. Among the prominent findings is that consumers attach little importance to the patient safety domain until they are given examples of how failures in this domain could impact patients. After discussions about patient safety, consumers tended to assign this domain the highest priority.

Conclusions and suggestions for hospitals and reporting organizations include:

  • Target improvement efforts to high-priority domains. Particularly important to consumers are emergency, life-saving clinical care; safety problems that may affect many patients; and clinical or safety problems that could have a devastating impact on individuals.
  • Spotlight patient safety. Reporting organizations should emphasize the significance of patient safety by reporting it as a separate quality domain. Hospitals should help consumers appreciate its importance.
  • Use the term "quality" with all domains. Consumers perceive "quality" to apply to responsiveness to patients and patient safety, as well as to clinical effectiveness.
  • Consider efficiency carefully. Although not currently a high priority, this domain may gain importance if rising health care costs increase patients' hospital cost-sharing burden.
  • Elicit the public's voice. As health care costs rise and trade-offs become inevitable, the public should be a key participant in conversations about quality priorities.

The complete report is available as a Document Download.

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