Vol. 27 No. 6 November/ December 2005 33 Hospital-Level Correlation Between Clinical and Service Quality Performance for Heart Failure Treatment Sabina B. Gesell, Paul Alexander Clark, Deirdre E. Mylod, Robert J. Wolosin, Maxwell Drain, Peter Lanser, Melvin F. Hall How does a hospital’s clinical quality relate to its service quality? Do both measures indicate the global health of the organization? Is it pos- sible for a hospital to have both high clinical quality and high service quality, or do resourc- es devoted to clinical improvement detract from service excellence? Should a hospital devote resources to improvements in clinical quality (e.g., investment in new equipment), or to service excellence (e.g., a new train- ing program)? As the hospital industry faces markedly increased public scrutiny, answers to such questions take on greater urgency. As with all quality initiatives, quality improvement (QI) begins with quality mea- surement (Berwick, James, & Coye, 2003). Evidence of pervasive overuse, underuse, vari- ation, and deadly errors within the healthcare industry (Committee on Quality of Health Care in America, Institute of Medicine [IOM], 2000; Schuster, McGlynn, & Brook, 1998) has pro- voked a swift revolution in national healthcare quality measurement policy and practice. Many of the quality measurement initiatives in health- care have focused solely on clinical quality. The national healthcare quality agenda now entails (a) the measurement and public reporting of an array of risk-adjusted outcomes (e.g., mortality, readmission) and non-risk-adjusted processes (e.g., whether an acute myocardial infarction [AMI] patient received aspirin and beta-block- ers within a certain amount of time), (b) the dissemination of clinical practice guidelines, and (c) the establishment of national improve- ment goals, all determined through evidence- based investigation (Leatherman, Hibbard, & McGlynn, 2003; McGlynn, 2003a, 2003b, 2003c; McGlynn, Cassel, Leatherman, DeCristofaro, & Smits, 2003; National Committee for Quality Assurance, 2003). For instance, the Centers for Medicare & Medicaid Services (CMS) is implementing a Hospital Quality Information Initiative (HQII) to publicly report hospital per- formance in 17 (soon to be 22) process-based measures of clinical quality (Clancy & Scully, 2003; CMS, 2003b; Stryer & Clancy, 2003). HQII measures were derived from research in which CMS developed and tested measures of out- comes (Cooper, Kohlmann, Michael, Haffer, & Stevic, 2001) and processes (Jencks et al., 2000; Jencks, Huff, & Cuerdon, 2003) to assess clini- cal quality among Medicare beneficiaries with- out the need for risk adjustment. For example, the clinical process measures used by CMS have been shown to have a direct relationship to clinical outcomes such as mortality. HQII and the supporting studies alone do not provide a complete profile of healthcare qual- ity. Improvements in the structure, processes, and outcomes of care require the integration of clinical and service quality measurements. The Institute of Medicine’s Crossing the Quality Chasm: A New Health System for the 21st Century patient-centered care requirement remains nota- bly absent from most reports of quality in health- care (Committee on Quality of Health Care in America, IOM, 2001). Integrating patients’ evaluations of their care with clinical measures Journal for Healthcare Quality Vol. 27, No. 6, pp. 33–44 © 2005 National Association for Healthcare Quality Abstract: A national cross-sectional study correlates the sat- isfaction ratings of heart failure patients (diagnosis related group 127) and the Centers for Medicare & Medicaid Services’ process-based quality measures for heart failure treatment for 32 hospitals during the first and second quarters of 2004. Two of the four measures of clinical quality showed statistically significant, moderately strong, positive correlations with a global measure of satisfaction and with, respectively, 5 and 7 subscales of the 10 subscales of satisfaction under examination (Pearson’s r ranged between .40 and .67, 2-tailed; p < .05). Findings demonstrate that quality need not be a zero-sum issue, with clinical quality and service quality competing for resources and attention. Key Words clinical and service excellence heart failure hospitals inpatients patient satisfaction quality of healthcare