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Inside the program: The three-legged stool of quality

HCPro's Weekly Update on the ANCC Magnet Recognition Program®*, April 12, 2010

Quality professionals often describe quality as a three-legged stool, with process, structure, and outcome measures holding up the stool. Although the results of the HCAHPS survey can be considered an outcome measure, there is another way to think about the patient experience that emphasizes its centrality to all of the aspects of quality. The patient experience can be considered the seat of the stool—essentially the purpose for which the legs exist. An organization can build a strong stool with three solid legs, but if the seat is missing or has tacks on it, no one will want to sit on it and the stool is not serving its purpose.

Similarly, it is possible for a hospital to focus exclusively on clinical quality metrics without considering the long-term relationships being built between and among patients and staff members. The hospital may receive a perfect score on the three “legs” (the outcome was good, the clinical process measures were satisfied, and appropriate structures are in place), but if the patient had a horrible experience and has lost confidence in the hospital and the clinicians, the hospital may have set the patient up for failure. The stool will eventually fall apart without a good seat to tie everything together.

Source: HCAHPS Basics: A Resource Guide for Healthcare Managers

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