"That Number Doesn't Reflect All I Do": Health Professionals' Perceptions of Quality Measurement in Health Organizations

Quality measurement of medical care has become common in health organizations. The rationale behind it is that using evidence-based professional standards, health organizations can improve the quality of care they provide. Publication of this improvement serves to increase transparency of these organizations while fueling health organizations' dominance with professional criteria. Thus, measurement is both an expression and an end of managerialism. However, the literature describes difficulties in the implementation of quality measurement and/or its publication from the point of view of both health professionals and organizations' administrators. We conducted a qualitative study in order to map the perceptions of key stakeholders and of hospital- and community-based physicians and nurses, regarding extant programs of quality measurement in the Israeli health system. The study included open-ended, in-depth interviews with stakeholders at various levels and in various sectors of the health system, and 11 focus groups with hospital- and community-based physicians and nurses. Data was analyzed using thematic analysis. This paper focuses on the perspectives of focus groups' participants (N=49). They tended to distinguish between quality measures and the quality of care they provide according to professional standards. Nurses appeared more comfortable with quality measurement programs in their work contexts, while physicians struggled to balance standardization with professional autonomy. Participants perceived too many measures are implemented, and that some of them are inappropriate vis-à-vis organizational and professional contingencies. They favored internal publication of quality measures results, but viewed publication to the general public with more skepticism. We conclude that professionals articulate familiarity, understanding, and positive attitudes towards quality measurement, especially if used to improve professional performance. On the other hand, they expose tensions between difficult-to-measure professionalism aspects and organizational managerialism. Quality measurement culture in health organizations needs to balance between professional and organizational tenets for patients' health continuous improvement.