Incentivizing Quality in the Manufacture of Pharmaceuticals: Industry Views on Quality Metrics and Ratings

BACKGROUND

An increasing number of industry-wide quality breaches and consequential drug shortages have fueled interest in finding better ways to improve the manufacturing quality of pharmaceuticals. Quality metrics offer a way of focusing FDA inspectional resources by using risk-based paradigms and communicating the quality status of different companies to other stakeholders. This exploratory study investigated industry views related to the use of quality metrics and ratings to help advance these discussions.

METHODS

A 23-question survey engaged 2 separate populations of industry professionals: a panel of identified US industry experts (n = 110) and a broader population (n = 328) of professionals working primarily in southern California.

RESULTS

FDA metrics most valued by industry were warning letters and other observations, often characterized as "lagging" metrics. Respondents were generally hesitant to share information that would establish "leading" metrics, such as process performance measures that may warn of problems earlier. Ratings were recognized to incentivize higher quality by broadening stakeholder influence. However, concerns were identified related to the equity, misuse, or misunderstanding of the rating schemes and underlying metrics.

CONCLUSIONS

Industry is an important stakeholder in the development of metrics. The concerns of industry must be recognized and addressed if policies related to metrics and ratings are to be effective in building an industry-wide quality culture.

Decision Analysis for Metric Selection on a Clinical Quality Scorecard

Clinical quality scorecards are used by health care institutions to monitor clinical performance and drive quality improvement. Because of the rapid proliferation of quality metrics in health care, BJC HealthCare found it increasingly difficult to select the most impactful scorecard metrics while still monitoring metrics for regulatory purposes. A 7-step measure selection process was implemented incorporating Kepner-Tregoe Decision Analysis, which is a systematic process that considers key criteria that must be satisfied in order to make the best decision. The decision analysis process evaluates what metrics will most appropriately fulfill these criteria, as well as identifies potential risks associated with a particular metric in order to identify threats to its implementation. Using this process, a list of 750 potential metrics was narrowed to 25 that were selected for scorecard inclusion. This decision analysis process created a more transparent, reproducible approach for selecting quality metrics for clinical quality scorecards.