From Quality Information to Quality Improvements — Interim Report: Summary and Analysis of Interviews with Health-Plan Managers

Since 2004, Israel has had a national program for monitoring the quality of the community-based health services provided by the country’s four non-profit health plans. The health plans are not required to participate in the program, yet all four Israeli health plans do so, on a voluntary basis.  Areas for which indicators have been developed include: immunization, cancer screening, diabetes care, asthma and cardiovascular care. To date, approximately 70 indicators have been developed and performance data on these, for the entire Israeli population, are published annually.

Almost all the indicators improved substantially during the program’s operation. For example, between 2005 and 2007, there was an improvement of over 20 percentage points in 10 of the 49 indicators for the two years on which there are data, and an increase of 10-20 percentage points in an additional 9 indicators.

Clearly, substantial improvements such as these do not occur magically or even automatically following data dissemination; they require a great deal of hard work on the part of health plan managers and professionals. Nonetheless, prior to this study, little was known about what exactly was being done within the health plans to turn quality information into quality improvements.

This study, which is based primarily on in-depth interviews with health-plan managers, explores the extent and nature of the organizational and behavioral changes made within the health plans subsequent to the initiation of the quality-measurement program. The focus of the analysis was on the types of changes that could reflect efforts to use data on past and current performance in order to improve future performance. The study also sought to identify similarities and differences across health plans in their efforts to improve quality. Finally, it examined the perceptions of leading managers and professionals of both the program’s contributions and its possible, undesirable side effects.

The findings reveal significant and varied efforts at multiple levels and these are detailed in the report. Moreover, the interviewees attributed an important role to the quality indicators in effecting change.

The challenge of using performance indicators to improve the quality of care is one that is faced by all types of health care organizations, around the world, be they hospitals, health plans, nursing homes, etc. The findings should be of interest to all those engaged in efforts to develop quality indicators as a tool to improve quality, whether in Israel or abroad.

This study was funded in part by the Israel National Institute for Health Policy and Health Services Research.