Column: Accountability – Physician and Professional Providers

This series titled “Column: Healthcare Accountability” is sponsored content from our partners at Axene Health Partners.  AHP offers highly specialized health care actuarial and consulting services across a number of states.  We have curated this content because we think it adds value to the work our readers are engaged in.  As always, we welcome your feedback on this series.

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This article is part of the Inspire series exploring accountability in key areas of today’s healthcare system. This article focuses on the accountability of physicians and other professional providers to “do the right thing” by maximizing quality. As described in the series overview, we have focused all the articles on what is known as the IHI Triple Aim.

In this article, the authors review the changing view of physician accountability and quality relative o each of the three Aims. This includes how quality is measured, how quality is used as incentive in physician reimbursement arrangements, and the resulting challenges and opportunities. We close with an informal rating of current provider accountability and off er some suggestions for next steps.

Accountability, Quality and “Doing the Right Thing”

Success in accountability requires knowledge of, and agreement to, what someone is being held accountable for. In this case it is useful to start by defining a few terms:

• Doing the right thing – According to Desmond Berghofer at the Institute for Ethical Leadership, this means to “make a choice among possibilities in favor of something the collective wisdom of humanity knows to be the way to act”.  YourDictionary defines it more concisely as “to do what is ethical or just.”
• Quality – The Oxford Dictionary defines quality as: The standard of something as measured against other things of a similar kind; the degree of excellence of something.
• Quality in Healthcare – In its report Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM (institute of Medicine) defines quality in healthcare as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”.
• Accountability in Healthcare – For purposes of this article we will use a working definition of accountability in healthcare as “maximizing quality” in one or more of the three Aims.

Based upon our findings from the literature and interviews with active physicians, we conclude that some physicians may not agree with the last definition above. Their definition often, understandably and importantly, begins with “accountability to their patients”. For purposes of this article we define “Doing the right thing by maximizing quality” as taking actions in healthcare that optimize the outcomes of one or more element of the Triple Aim.

Continue reading the column here.