Quality indicators and monitoring of mental health services: what do frontline providers think?

Abstract

Objective: Many health care organizations are giving feedback to mental health care providers about their performance on quality indicators. Mental health care providers may be more likely to respond to this feedback if they believe the indicators are meaningful and within their "sphere of influence." The authors surveyed frontline mental health care providers to elicit their perceptions of widely used indicators for quality monitoring in mental health services.

Method: The survey was distributed to a stratified, random sample of 1,094 eligible mental health care providers at 52 Department of Veterans Affairs facilities; 684 (63%) returned the survey. The survey elicited perceptions of 21 widely used indicators in five quality domains (access, utilization, satisfaction, process, and outcomes). The data were analyzed with descriptive and multivariate methods.

Results: Most mental health care providers (65%) felt that feedback about these widely used indicators would be valuable in efforts to improve care; however, only 38% felt able to influence performance related to these monitors and just 13% were willing to accept incentives/risk for their performance. Providers were most positive about satisfaction monitors and preferentially included satisfaction, access, and process monitors in performance sets to measure overall quality. Despite providers' relatively positive views of monitors, 41% felt that monitoring programs did not assist them in improving care. Providers cited numerous barriers to improving care processes.

Conclusions: Mental health care providers may be more receptive to monitoring efforts if satisfaction, access, and process monitors are emphasized. However, providers' views of monitoring programs appear to be less affected by concerns about specific monitors than by concerns about the accuracy of quality measurement and barriers to changing care processes.