"What’s so hard about measuring quality? A major problem is that the caregivers who deliver care, and the patients who receive the care, have been disengaged from the discussion about what it really is. That discussion has been ceded to governmental agencies, which have generally gotten it wrong. Doctors become frustrated because the bureaucratic version of quality doesn’t ring true, and the process of improvement gets stuck at this earliest step.
Why shouldn’t the caregivers themselves, meaning doctors and nurses, with input from patients, say what quality really is? If the doctors and patients don’t know, we are all in trouble. This sensible approach hasn’t come from any governmental authority, but rather from a regional third-party payer, Blue Cross/Blue Shield of Michigan. What has resulted is a standardized and more informed definition of quality, and also a statewide framework for quality improvement that caregivers see as reliable and useful."