No consensus on what defines a high-performing health system, AHRQ study finds

a hospital corridor
What exactly defines a high-performing health system? Researchers aren't sure. (Getty/sudok1)

There isn’t much agreement on what exactly defines a high-performing health system, according to a new study.

Researchers funded by the Agency for Healthcare Research and Quality reviewed 57 articles and other studies published between 2005 and 2015 to determine if there is a definition that is widely agreed upon. Instead, they found no consistent results and factors varied widely between articles, according to the study published in the Joint Commission Journal on Quality and Patient Safety.

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Some of the more common factors included:

The majority of articles in the review (75%) used more than one factor to rate performance, but just five included five or more factors in defining high performance. Quality and cost were most commonly taken together, paired in 63% of the reports.

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The lack of a clear definition on what constitutes high performance can hinder the healthcare system from rewarding and identifying the most effective health systems, the researchers said.

“The absence of a consistent definition of what constitutes high performance and how to measure it hinders our ability to compare and reward health care delivery systems on performance, underscoring the need to develop a consistent definition of high performance,” noted the authors.  

The results underscore a significant problem in healthcare as whole: that it has not found its purpose, said Peter J. Pronovost, M.D., director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, in an accompanying editorial.

The industry as a whole must operate under a clear purpose statement before these definitions can be clear and stick widely, he said.

“A high-performing health system should be defined, simply, as one that is more likely to achieve its purpose,” Pronovost said. “Until we are clear on the purpose, performance will suffer.”