Clinician-Directed Performance Improvement: Moving Beyond Externally Mandated Metrics.

Pay-for-performance and public reporting programs have successfully focused hospitals' attention on quality. But they have also had unintended consequences, including encouraging a narrowing of focus to mandated metrics, and their effectiveness in improving outcomes remains uncertain. Moreover, they have not successfully engaged clinicians. To offset these deficiencies, a community hospital in Santa Fe, New Mexico, developed a clinician-led quality improvement program that was parallel to its traditional quality program. Called Clinician-Directed Performance Improvement (CDPI), the program is designed to give clinicians the protected time, support, and training to select and conduct performance improvement projects. Since its implementation in September 2015, CDPI has been associated with large improvements in quality and physician engagement and has generated net savings. This article discusses the program, its results, and policy implications.