When you hear hoofs, think horses, not zebras: an evidence-based model of health care accountability

Kazandjian, Vahé A. PhD MPH

President, Center for Performance Sciences, and Adjunct Associate Professor, The Johns Hopkins University, School of Hygiene and Public Health, Elkridge, MD, USA

Correspondence Dr Vahé A. Kazandjian President, Center for Performance Sciences, Adjunct Associate Professor, The Johns Hopkins University, School of Hygiene and Public Health, 6820 Deerpath Road, Elkridge, MD 21075, USA. E-mail: [email protected]

Accepted for publication: 4 February 2002

Journal of Evaluation in Clinical Practice 8(2):p 205-213, May 2002.

Abstract

Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is discussed.