September 7, 2017

No consensus on what defines a high-performing system

By: Judy Mathias

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.

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