compile the leadership and organizational attributes, functions, and processes associated with high performers into an organizational self-assessment tool; and share the findings in order to facilitate improvements in quality.

Considerable progress has been made in reviewing the research and cross-walking the findings that Dr. Kroch discussed into 12 dimensions around which hospital structures and processes associated with high-performers can be measured through the HLCAT. The plan is to field-test the tool with voluntary hospital participants and deploy it as a CMS-endorsed assessment tool. In addition to promoting transformational hospital leadership change, leading to quality improvement, the HLCAT will provide information to support other CMS-sponsored projects, such as the development of new metrics for public reporting and Pay-For-Performance (P4P), as well as the development of regulatory conditions of participation. The tool will also potentially provide benchmarks for establishing milestones and measuring the progress of quality improvement.

Ms. Archer reviewed the 12 common findings from research discussed by Dr. Kroch and identified specific attributes that could be measured for each of the dimensions. For example, direct board involvement, a characteristic of leadership, could be measured by the percentage of board meeting time dedicated to quality improvement, the existence of a quality subcommittee charged with in-depth analysis and review of quality initiatives, and the requirement for board members to take formal quality improvement education. As another example, medical and nursing leadership engagement, a characteristic of structure and process, could be measured by whether medical staff are provided with information on P4P and whether there is physician and nursing representation on the board. In a final example, engagement with consumers, a characteristic of external resources, could be measured by the existence of satisfaction surveys, leadership walk-arounds, and community outreach efforts.

The HLCAT is formatted using a milestone approach. That is, there will be a series of statements describing various kinds and degrees of behaviors that exhibit different levels or gradations of commitment to quality improvement. The advantage of this approach is that it will provide hospitals with granular data in determining exactly where their leadership and cultural challenges are situated. Hospitals will be able to evaluate their current situations, but will also know which behaviors to aim for in transforming their cultures. The workgroup has developed benchmarks to set quality improvement goals in terms of "critical," "below average," "average," "above average," and "exemplary" behaviors. These benchmarks can be used to set quality improvement goals for the organization. While the HLCAT focuses on assessing internal and relatively tractable aspects of a hospital’s leadership, culture, and processes, ultimately the workgroup would like to investigate more thoroughly the less tractable factors that can have a determinative influence on performance.