HC Policy Power Players Series: National Quality Forum

By: Annie Martello

National Quality Forum

At TogoRun, we pride ourselves in finding and telling the untold stories—stories about important people and organizations who have not received the recognition they deserve.

When it comes to healthcare policy in the U.S., the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and the White House are household names; however, there are many other groups frequently overlooked despite their influence in building the future of healthcare.

In this edition of HCPolicy Power Players, we focus on profiling the non-profit/non-partisan National Quality Forum (NQF).


The National Quality Forum is a non-profit and non-partisan membership organization whose mission is to drive improvements in healthcare. The NQF was established in 1999 based on recommendations made by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. These recommendations concluded that an organization was needed to promote and ensure patient protections and healthcare quality through measurement and public reporting. Its current President and CEO is Christine K. Cassel, who previously held the same title at the American Board of Internal Medicine (ABIM) and the ABIM Foundation.

The NQF is comprised of more than 400 member organizations that represent a vast range of healthcare interests. From consumers and physicians, to government and public health agencies, to pharmaceutical and medical device companies, the NQF spans the spectrum of healthcare.

What It Does

The NQF works to achieve its mission by setting and shaping national quality improvement priorities, endorsing and setting national standards, advancing electronic measurement, and promoting outreach and education programs.

Shaping Priorities

Through NQF-convened partnerships, like the National Priorities Partnership (NPP), the NQF helps to set and shape national healthcare improvement priorities and then determines the best course of action to meet them. The NPP is a cooperative of 52 major national organizations with a shared vision to create a healthier population through a safe, effective, equitable and value-driven healthcare system. Through the NPP, the NQF was able to establish a national blueprint for achieving this high-value healthcare system—The National Quality Strategy. The NQS sets clear goals to help the nation focus its efforts and have a coordinated plan of attack.

Setting Standards

The National Quality Forum uses a rigorous and formal process to evaluate and endorse several different kinds of standards—performance measures, best practices, frameworks and reporting guidelines. NQF’s “Consensus Development Process” involves eight steps:

  1. Call for nominations
  2. Call for candidate standards
  3. Candidate consensus standard review
  4. Public and member comment
  5. Member voting
  6. Consensus Standards Approval Committee (CSAC) decision
  7. Board ratification
  8. Appeals

Advancing Electronic Measurement

The National Quality Forum has developed health IT initiatives to support the prevailing move toward electronic measurement. In 2011, the NQF converted 113 of its endorsed quality measures into an electronic format—eMeasures. eMeasures provide greater consistency and standardization in measuring performance results. In 2011, the NQF also released the Measure Authoring Tool, which allows for the development of standardized eMeasures for use across electronic health records (EHRs) and clinical IT systems.

Additionally, the NQF has developed the Quality Data Model (QDM). The QDM is an information model that acts as a guide for the effective automation and standardization of electronic health record use. The QDM makes data entered into EHR systems more easily measurable and identifiable.

Outreach and Education

The NQF provides reportstools, events and information for use by physicians, healthcare communicators, consumers and others in the healthcare industry. Some of its main outreach and educational materials include: a directory of reports, endorsement summaries, endorsed measures, graphics, a Health IT knowledgebase and an action registry.

The Impact

Why Quality Standards Matter

In 1999, the Institute of Medicine estimated in its famous “To Err Is Human” report, that as many as 44,000 to 98,000 people die in U.S. hospitals each year as the result of medical errors. More recent studies report that these numbers are actually much higher than previously believed. According to a 2013 estimate published in the Journal of Patient Safety, more than 400,000 Americans die annually in part because of avoidable medical errors.

These errors also have a serious fiscal impact. One of the most recent studies to measure these expenses found that medical errors cost the country around $19.5 billion annually, most of which is spent on extra care and medication.


Due to its stringent and involved consensus process, NQF-endorsed measures are considered the “gold standard” for healthcare measurement in the U.S. The federal government and many other private sector organizations use NQF-endorsed measures above all others and nearly all are in use.

Apart from its endorsed standards, one of the initiatives the NQF is best known for is the creation of its report on Serious Reportable Events (SRE) in 2009. Serious Reportable Events are “preventable, serious, and unambiguous adverse events that should never occur.” These events usually end in death or serious harm to a patient due to medical error and are often referred to as “never events,” as they should never happen. The NQF has compiled a list of 28 SREs in six categories— surgical, product or device, patient protection, care management, environment and criminal. By identifying these SREs, the healthcare industry can work to eliminate them.

Today, the NQF continues to push for the reduction and proper handling of medical error. One of its recent initiatives includes advocating for legislation that would require hospitals to adopt written policies that address the management of adverse events.

The Bottom Line

The NQF persists as one of the strongest voices in championing the enforcement of quality in all areas of healthcare. It can be counted on to advocate on behalf of all major legislation and initiatives that focus on improving the healthcare system. Its strong advocacy for policies to promote safe and high-quality healthcare coupled with its leading-edge efforts makes the NQF an organization to know and follow.