What Exactly Is a "High-Performing" Health System?

Despite all the time, money, and energy spent on improving healthcare quality and value, there is no “overarching concept” or consistent definition of what constitutes a “high-performing health system,” a review by The Joint Commission has found.

“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,” the review found.

In their search for a consistent definition of the term, The Joint Commission researchers sifted through English-language articles defining high performance with respect to a healthcare system or organization in PubMed and WorldCat databases from 2005 to 2015 and the New York Academy of Medicine Grey Literature Report from 1999 to 2016. The entity/condition to which the definition was applied was extracted from included articles.

The number and type of dimensions used to define high performance within and across articles was tabulated and the number and type of metrics used by performance dimension and by article was calculated.

Instead of a consistent definition, the researchers found that high performance was variably defined across different dimensions, including quality (93% of articles), cost (67%), access (35%), equity (26%), patient experience (21%), and patient safety (18%).

Most articles used more than one dimension to define high performance (75%), but only five used five or more dimensions. The most commonly paired dimensions were quality and cost (63%). 

The Joint Commission researchers said in their review that measuring performance in the nation’s healthcare delivery system “has gained significant traction” over the years with policy makers, even though they apparently do not have a consistent definition of the term.

To support delivery system improvement nationally, the Agency for Healthcare Research and Quality recently funded three Centers of Excellence to study high-performing systems, particularly their ability to quickly move new evidence-based care practices into practice, The Joint Commission review noted.

“Research to understand what enables healthcare delivery systems to perform highly, and policy efforts to measure and recognize high-performing health care delivery systems, is predicated on an agreed-on definition of what it means to be high-performing,” the researchers said.

“Achieving consensus on what it means to be high-performing is essential to facilitate comparisons across delivery systems and in applied measurement activities, such as programs that designate and publicly recognize high performers.”

By John Commins, senior editor at HealthLeaders Media.