The Quality-Cost Connection: Are your customers also partners in PI initiatives?

By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR

Does your organization provide consumers and the community with opportunities to be involved in shaping your services and performance improvement initiatives? If the answer is "no" or "not very often," senior leaders and staff are missing out on valuable information. There is a growing recognition of the value of consumer and community input in redesigning the delivery of health care services.

To tap into this resource, health care organizations must learn how to effectively involve consumers and community members as agents of change. The term "consumer" refers to any users of health services or their families. The term "community" refers to either a particular community group (e.g., culturally determined group, disease-oriented group, or an interest group), area where the hospital is located, or catchment area for the hospital. Consumer and community participation can be at different levels of your organization. High-level involvement includes activities such as strategic planning, policy development, and evaluation of care and services. Low-level involvement ranges from minor participation (information giving and information seeking) through more interactive participation (group or one-on-one interactions and partnerships).

The importance of consumer and community involvement is supported by the recommendations of several external groups, including the Joint Commission on Accreditation of Healthcare Organizations and the Baldrige National Quality Program in Gaithersburg, MD.1 The leadership standards of the Joint Commission call for consideration of patient and family needs and expectations when planning for and designing services. In the chapter on ethics, rights, and responsibilities are standards related to involving patients in decisions about care, treatment, and services provided. The Baldrige Health Care Criteria for Performance Excellence address consumer and community involvement in the leadership category and the category Focus on Patients, Other Customers, and Markets.

The criteria encourage health care organizations to involve consumers and the community in strategic planning and have mechanisms to obtain feedback about key patient/customer requirements and expectations. This feedback, along with other information, is to be used by the organization’s leaders to ensure current health services are adequate and to establish future business directions. Senior leaders in organizations striving for excellence view feedback and participation from consumers and the community as a vital component in performance improvement initiatives.

There is no one right way of enabling consumers and the community to participate in your organization’s performance improvement initiatives. However, if the involvement is poorly planned and managed, the results will be less than optimal.

First, the organization must identify clearly its consumers and community members and define the purpose and mechanisms for involving them. For maximum benefit, consumer and community participation should be part of an overall management organizational strategy, rather than a series of ad hoc projects.

The following audit tool can be used for evaluating the level of commitment to consumer and community participation in your organization. The questions range from those on management issues (Part I) to activities at the department level (Part II). Both parts could be completed by the quality manager through interviews with relevant senior leaders and managers and by reviewing documents. Another approach is for the quality manager to gather information for Part I of the tool and ask department managers to conduct their own self-assessment by answering Part II questions.

Once information is gathered, it can be analyzed and reported to the board, senior leadership team, managers, and staff. The results are a measure of the organization’s commitment to and activity in consumer and community involvement. Use the information to identify organizational strengths, as well as gaps and limitations. Priorities should be established to develop an organizational approach to consumer and community participation.


  1. Baldrige National Quality Program. Health Care Criteria for Performance Excellence. Gaithersburg, MD; 2004. Web site: