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International Journal for Quality in Health Care Advance Access published online on December 15, 2006
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzl067
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© The Author 2006. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted November 22, 2006

Article

How to develop a business case for quality

Kristin L. Reiter 1 *, Kerry E. Kilpatrick 1, Sandra B. Greene 2, Kathleen N. Lohr 3, and Sheila Leatherman 1

1 Department of Health Policy and Administration, NC, USA
2 Department of Health Policy and Administration, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
3 Department of Health Policy and Administration, NC, USA; RTI International, Research Triangle Park, NC, USA

* To whom correspondence should be addressed.
Kristin L. Reiter, E-mail: reiter{at}email.unc.edu


  Abstract

Objective. To describe the steps in developing a business case for quality-enhancing interventions (QEIs) in health care.

Analysis. The development of a business case for QEIs in health care involves 11 steps. These steps include (1) describing the intervention, (2) determining perspective, (3) identifying the effects of the intervention on quality, (4) designing the study, (5) identifying and measuring cash flows, (6) considering the effects of capacity constraints, (7) selecting a measure of return on investment, (8) determining the time horizon for the analysis, (9) determining the discount rate, (10) adjusting costs and savings for inflation, and (11) determining organizational readiness for business case development. A checklist offers guidance on assessing readiness for the business case.

Conclusion. The absence of a ‘business case’ for quality is frequently cited as the reason health care organizations do not implement QEIs, despite decades of careful research demonstrating their effectiveness. Our continuing commitment to advancing the discipline of business case analysis is based on a belief that delineating the cost and economic implications of investments in QEIs is a critical threshold issue to widespread adoption of evidence-based quality improvements. We believe it is appropriate and timely to consider how best to standardize approaches and move the field of business case analysis forward.

Keywords: business case for quality, business case methods, return on investment, quality improvement.
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