Dennis S. O'Leary, M.D., is president of the Joint Commission on Accreditation of Healthcare Organizations. Under his leadership, the Joint Commission has successfully modernized its accreditation process to focus on the actual performance of individual health care organizations and to emphasize the use of measurement to drive continuous improvement in organization performance. In recent years, he has overseen the introduction of cutting-edge standards relating to patient safety, pain management, use of patient restraints, and emergency preparedness, and he has led the formulation of National Patient Safety Goals which have also been incorporated into the Joint Commission's accreditation process.

Prior to joining the Joint Commission, Dr. O'Leary served as dean for Clinical Affairs at the George Washington University Medical Center and vice president of the George Washington University Health Plan, an academic HMO. During his 15-year tenure at George Washington, he achieved the faculty rank of Professor of Medicine, and served for a decade as Medical Director of the University Hospital.

Question #1:

In your opinion, what are the most significant obstacles to achieving and rewarding provider quality?

The most significant obstacles to achieving and rewarding provider quality are:

• Failure to reach broad consensus on a set of principles to guide the construct of pay-for-performance programs.
• The difficulty in aligning priorities and payment incentives among physicians, provider organizations, payors, and patients.
• The insufficiency of high quality metrics to underpin pay-for-performance programs.

In your opinion, what are the most forward thinking initiatives or solutions that should be widely explored to achieve the systematic change necessary for successful pay-for-performance?

Potential and actual initiatives that should be actively pursued to achieve the systematic changes necessary to the effective function of pay-for-performance programs include:

• Creation of a national health care quality leadership platform at the level of the Secretary of Health and Human services to set national quality goals and to establish priorities and assure funding for relevant performance measure sets.
• Continued efforts to establish an inter-operable national IT infrastructure for health care that, at the least, provides for electronic health records and practitioner decision support.
• The identification and/or design of reliable patient safety measures that can provide meaningful information to the public and other key audiences.

Please expand on any initiatives with which you are currently involved that benefit your organization or the health care industry.

The Joint Commission is actively involved in the following initiatives that are intended to benefit the public, practitioners, provider organizations, and payors:

• The creation of an International Collaborating Center for Patient Safety whose principal goal is to gather, evaluate, package, and disseminate patient safety solutions both in the United States and across developing and other developed countries.
• The continued development and/or evaluation of performance metrics, in collaboration with other measurement leadership groups, to the end of producing high quality metrics that can be used to support quality improvement, public reporting, and pay-for-performance initiatives.
• The continued elaboration of public policy white papers that address key impediments to efforts to improve patient safety and health care quality such as health professional shortages, the medical liability system, and health literacy.

Please provide highlights of your presentation at the Leadership Summit and any preliminary results or data that can be shared.

My presentations at the Summit will describe the Principles for the Construct of Pay-for-Performance Programs that the Joint Commission has issued, and separately address the major patient safety initiatives in which the Joint Commission is engaged. The former will elaborate the key issues which must be effectively resolved by pay-for-performance programs, and underscore the potential importance of these programs as instruments of social and behavioral change toward the goal of safe, high quality care for patients. The latter will focus on the initiatives encompassed in the new WHO World Alliance for Patient Safety and their potential impacts in both developing and developed countries, and on strategies for achieving practitioner and provider organization ownership of patient safety solutions.

Question #5:

Please state what you hope to achieve by participating in the 3rd Annual World Congress Leadership Summit on Health Care Quality and Pay for Performance Contracting.

The Leadership Summit provides a rich opportunity to be updated on current knowledge and thinking about important patient safety, health care quality, and pay-for-performance issues, and to talk informally with leaders in these arenas.