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Improving performance on core processes of care

Austin, John Matthew; Pronovost, Peter J.

Current Opinion in Allergy and Clinical Immunology: June 2016 - Volume 16 - Issue 3 - p 224–230
doi: 10.1097/ACI.0000000000000260
OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez

Purpose of review This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work.

Recent findings The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance.

Summary Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

aArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine

bDepartment of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University

cDepartment of Health Policy and Management, Bloomberg School of Public Health

dSchool of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.

Correspondence to John Matthew Austin, PhD, Armstrong Institute for Patient Safety and Quality, 750 E. Pratt Street, 15th Floor, Baltimore, MD 21202, USA. Tel: +410 637 6263; e-mail:

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