Applying continuous improvement in public reporting: What should government reports do for quality improvement?

This paper aims to describe the history and growth of mandatory public reporting of healthcare-associated infection rates and the philosophy and implementation of an evidence-based total-quality-oriented state government program and also to provide critical appraisal of recognized assumptions underlying this movement. This paper provides a narrative review of pertinent evaluation research literature and the authors' own experience. Washington is one of few states that hired experts in the subject area to develop its new program. It is one of the first exploring optimal ways to validate the rates reported, and one of very few taking evidence-based approaches to all aspects of program design. The work provides a model for less-developed agencies to follow. This is a new and unprecedented role for state health departments, but offers opportunities to raise standards of practice through continuous quality improvement approaches with hospital partners while regaining public trust through transparency. Weak evidence supporting fundamental assumptions, and failure of prior approaches, indicate that we must explore new paths rather than follow established ones.