Measuring performance in a healthcare environment can face several barriers, many of them deriving from the process of implementing a measurement system. The Joint Commission (2001) identified several such pitfalls that may make determining performance levels difficult.  These include staff concerns about “over standardized” treatments; lack of understanding by staff of how data collection and analysis is done; concerns that the measurement process will be an extra burden for overworked staff; and worries about how the resulting performance measures would be used. Since data collection nearly always requires staff compliance and cooperation, it is important to gain the cooperation of medical staff and to ensure their concerns are addressed before initiating a measurement process.

Because healthcare institutions are heavily regulated, it is important that quality measures be in compliance with accepted standards. The Joint Commission has identified core dimensions of performance of efficacy, appropriateness, availability, timeliness, effectiveness, continuity of care, safety, efficiency, and respect for patients. (The Joint Commission, 2001). A 2006 report suggests that measurement efforts also address three types of measures: structural measures, which consider the organizational structure and whether it meets the needs of the patients; process measures, which examine whether evidence-based, correct procedures are being followed; and outcome measures, which identify whether contemporary best-practices efforts are being followed (Sorian, 2006). One way of determining specifics of measurements is to make use of existing measures as specified by The Joint Commission and their quality specifications outlined by their accreditation standards.  Another is to use other accepted quality measurement instruments, adapted to be appropriate for the specific needs of the institution.