No consensus on what defines a high-performing system

Editor's Note

In this study, researchers reviewed literature from a 10-year period and found no consensus on what defines a high-performing healthcare delivery system or healthcare organization.

High performance was variably defined across different dimensions, including:

• quality (93% of articles)
• cost (67%)
• access (35%)
• equity (26%)
• patient experience (21%)
• 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 common dimensions were the combination of quality plus cost (63%).

The absence of a consistent definition hinders the ability to compare and reward healthcare systems on performance, the authors say.

Purchasers, payers, and policy makers are increasingly measuring and rewarding high-performing health systems, which use a variety of definitions of high performance, yet it is unclear if a consistently applied definition exists. A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a “high-performing” health care delivery system.