A framework for improving the performance of health care organizations.

This performance improvement framework incorporates several key assertions: Performance means what is done and how well--what jobs are done to provide health care and how effectively they are carried out. Joint Commission standards manuals are being reorganized to address the most important governance, management, clinical, and support functions. The effect of an organization's performance of these functions is reflected in patient outcomes, in the cost (or efficiency) of its services, and in patients' and others' perceived satisfaction. Patients and others judge the quality of health care based on health outcomes (and sometimes on their experiences with the care process and level of service provided). Patients, purchasers, regulators, and other stakeholders expect and use quantitative/explicit data and qualitative/implicit perceptions to judge quality and value of health care. The framework for improving performance describes a global model for organizations that intend to be diligent, rigorous and effective in their pursuit of excellence. Its three components--external environment, internal environment, and operational improvement methodology--are not a "cookbook" of required activities. Rather, they represent a synthesis of important concepts, organizational characteristics, management techniques, and scientific tools and methods that together make continuous improvement possible. This improvement framework poses major challenges to health care organizations. These challenges include becoming more patient-focused, redesigning care processes, promoting collaborative teamwork, systematically measuring and assessing performance, and encouraging risk-taking and experimentation. Nonetheless, the ability to proactively and effectively manage quality is the only way that organizations will be able to survive and prosper in the face of stringent resource constraints and ever-increasing demands for better health outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)