TY - JOUR T1 - Using report cards and dashboards to drive quality improvement: lessons learnt and lessons still to learn JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2017-007563 SP - bmjqs-2017-007563 AU - Noah M Ivers AU - Jon Barrett Y1 - 2018/01/09 UR - http://qualitysafety.bmj.com/content/early/2018/01/09/bmjqs-2017-007563.abstract N2 - More than 50 years of health services research has driven home a core lesson: unintended and inappropriate variations in care are common.1 2 Identification of such variation in obstetrics was the impetus for Archie Cochrane to start his work.3 In this issue of BMJ Quality & Safety, Weiss and colleagues report an intervention developed to address inappropriate variation in aspects of maternal newborn care across Ontario, Canada’s most populous province.4 The intervention involved systematic collection and analysis of administrative data to assess key quality indicators for all hospital births in the province and provision of this data in a ‘dashboard’ back to hospitals.Measuring quality of care and comparing this against agreed-upon standards of practice or peer performance (ie, audit) and delivery of the results to healthcare professionals and/or administrators (ie, feedback) is a common quality improvement strategy.5 Whether referred to as ‘audit and feedback’, ‘report cards’, ‘benchmarking’, ‘practice profiles’ or other synonyms, the underlying rationale for audit and feedback is sound. The large literature evaluating this approach indicates that (1) clinicians are relatively poor at self-assessment,6 meaning that they tend to pursue continuing professional development or quality improvement in areas of interest (where performance is often already high) rather than areas of greatest need; (2) comparing current performance to a target can drive increased performance in motivated individuals,7–9 meaning that when desired behaviours can be measured and presented in a formative fashion,10 health professionals may respond positively to them; and (3) high-performing health systems tend to feature audit and feedback as an evidence-based, scalable and relatively inexpensive strategy to encourage uptake of best practices.11The use of dashboards to encourage reflection on quality of care is expanding. In 2009, the National Health Service adopted a maternity dashboard; several countries and institutions … ER -