The government has set out its vision for an information revolution, which will see much more information about the quality of health care providers being made publicly available. This year, for the first time, providers were required to publish quality accounts. Does this new information mean the public and patients have a clearer view of the quality of care provided locally?
Our latest publication, How do quality accounts measure up?, reviews a sample of the first year's accounts, looking at their compliance with the statutory requirements and guidance, and asking how well they meet the principles of good practice in publishing information on quality. As we probably all would have predicted, they vary greatly, with examples of good and poor practice, and great variation in style, content and intended audience.
Some quality accounts included more than 100 quantitative indicators, while others used only a few. Some took care to describe and explain the information they were presenting, and did this with great skill; others provided reams of tables and graphs of interest to the expert, but of limited use to the public and patients. And while some reports included lengthy and considered comments from local involvement networks and primary care trusts, others contained no external comments whatsoever.
Given this variation in their quality are quality accounts useful? Some variation is to be expected in the first year of any major new reporting requirement. Organisations will hopefully learn and improve their accounts in future years.
And while there are some cases of quality accounts with basic errors – missing information, blurred or mislabelled graphs, typographical errors, confusing layouts – many organisations appear to have worked hard to produce documents which are meaningful and readable.
More fundamentally, the variation in reporting practices is caused as much by the design of the policy as by its implementation. Providers are not required to report on a set of core measures that can be compared across all providers, instead the policy allows providers local flexibility in the information they choose to include. Enabling organisations to report on the quality issues that matter to them locally undoubtedly helps them to focus on local priorities for improvement: however, it makes it difficult for the information to be a meaningful tool of public accountability.
If quality accounts are to have a useful role in improving quality locally, they need to include standard, consistent and comparable measures, and be published in forms that enable interpretation and comparison. Quality accounts are a good first step in the government's planned 'information revolution', but to fully deliver a meaningful and transparent picture of quality for patients and the public, providers will need to give a clearer account of the quality of care in future.