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July 30, 2019
This is the eighth and final Trust Practice Challenge winner to be featured in this letter. Next month, all eight outstanding submissions will be showcased at the annual ABIM Foundation Forum.
The members of the Wisconsin Collaborative for Healthcare Quality (WCHQ), led by Chris Queram, have publicly reported ambulatory quality measures at both the health system and practice-site levels since WCHQ’s inception in 2003. Performance data on WCHQ members – 35 health system and 325 medical clinics– is readily accessible at www.WCHQ.org. WCHQ expects to begin reporting data from several oral health practices in 2020.
According to their Trust Practice Challenge submission, “WCHQ members [which include more than 65 percent of the state’s primary care physicians] also use the data for internal improvement and can evaluate performance down to the level of the individual clinician. In addition, WCHQ serves as a convener and facilitator of collaborative learning sessions that focus on the sharing of best practices.”
“The combination of transparent public reporting and sharing of best practices epitomizes an environment of reciprocal trust. Members trust that WCHQ will be a faithful and diligent steward of their data and that, in return, WCHQ will generate valid and reliable measure results that are used in the spirit of public accountability, collaboration and improvement.”
The Collaborative adheres to a set of core values, and trust is number one. Trust is defined in this context as not using performance data for market advantage. The remaining values reinforce, amplify and advance this foundational precept through commitments to participation, inclusiveness, shared responsibility, openness, adaptive self-governance, intellectual output and transparency. To advance those values and engage providers in public reporting and a learning collaborative, WCHQ has an inclusive governance structure and an emphasis on relationship management. They focus on their relationships with leaders and experts at health systems to encourage sharing performance information.
Why is transparency and public reporting a trust builder?
- When organizations report their performance, they give up power and control, leaving themselves vulnerable; at such times, trust becomes a major factor.
- Hiding performance invites suspicion: what are you hiding or do you think I am not smart enough to be helped by having this information?
- Trust was essential in sharing the data – the contributing organizations needed to know if WCHQ could reliably gather the data and competently report out. Reliability and competence are two key trust builders.
- The promise of sharing best practices and learning collaboratives was authentic and provided value, both of which are needed for sustainable support.
- Organizations in the collaborative needed to trust each other and not use the data to gain an edge in the marketplace. A breach could have a lasting effect on trust.
- Key parties backed these efforts, including employers and health plans, and would not tolerate a betrayal of trust. Sometimes a watchdog is needed to assure trust is not broken.
WCHQ embodies the “Wisconsin idea,” which is to share information that improves the health and quality of life for all citizens. Sharing requires trust between those that provide the information and those who find it useful.
Daniel B. Wolfson
EVP & COO, ABIM Foundation