Improving health care systems performance: a human factors approach.

Under contract from the Centers for Medicare & Medicaid Services (CMS), Medicare Quality Improvement Organizations (QIOs) promote improvement in health care system performance. With the QIO contract cycle that began in the fall of 1999, CMS adopted a broad national improvement agenda emphasizing 24 quality measures from 6 clinical topic areas. The Utah QIO developed a human factors and organizational safety management-based intervention strategy for the inpatient clinical topic areas, borrowing approaches and principles previously applied in hospital-based medication systems safety improvement efforts. Evaluation used measures and methods established by CMS to assess the adequacy of QIO performance nationwide. Comparison of statewide inpatient quality indicator performance rates in 1998 and 2000 showed absolute improvement on 15 of the 16 measures used. The average reduction in the failure rate for these clinical topic areas in Utah was 27.3%; this was the highest rate of improvement for any state in the nation. Utah's overall ranking on the combined inpatient clinical topic areas went from 16th at baseline to first at follow-up. The evaluation demonstrates exceptional levels of performance improvement in Utah hospitals when compared with national trends. It is, however, neither possible to uniquely isolate the effects of the QIO intervention from larger trends operating statewide, nor can the contributions of the various facets of the QIO intervention be disaggregated. The application of human factors and organizational safety management principles represents a promising strategy for accelerating the pace of improvement in health care.