Clinical practices. We define clinical practices as adherence to relevant national or local standards, not only in the screening and treatment of patients but also in the education and accreditation of the labor pool, as well as the accreditation of facilities. These safeguards aim to improve diagnoses, increase adherence to well-documented practices, and reduce the incidence of harmful errors The lack of reliable data on quality, safety, and service can hinder the devel opment and monitoring of the most effective treatments Medical literature provides growing evidence of the efficacy of particular diagnostic and thera peutic protocols that reduce morbidity and mortality. Health care facilities that follow established protocols get higher-quality outcomes Hospitals with the highest adherence to evidence-based protocols for the treatment of pneumonia, for example, have 20 percent fewer complications and 25 percent fewer readmissions than hospitals with the lowest adherence However, we found that health care providers in the countries we studied fail routinely to use the available protocols properly. In Germany, for instance, 35 percent of diabetes patients in one survey reported that their annual checkup didn t include an examination for foot ulcers, one of the normal complications of chronic diabetes For more about evidence-based management outside of health care, see"Managing your organization by the evidence The availabilty ofinformation. Health systems can promote evidence-based medicine by making real-time information on key outcomes and practices freely available to policy makers, insurers, providers, and the public. Studies in the United States have shown differences in quality between health care organizations that issue reports publicly and those that don t. The mortality rates of cardiac departments in the United Kingdom im proved markedly once these rates were published Risk-based monitoring and audits Safeguarding quality also requires a comprehensive system to assess the delivery of health care and to recommend intervention for failure or underperformance. National inspection and intervention regimes work best when they allow for both risk-based monitoring (for example, more detailed monitoring of higher-risk organizations)and proportional intervention (no action below specific thresholds, for instance, and heavy intervention in cases of significant concern for the safety of patients) Nonetheless, the most im portant inspection processes are those of the providers themselves. Leading hospitals build performance reviews into operating meetings put these reviews on the agendas of key committees, and integrate the reviewsClinical practices. We define clinical practices as adherence to relevant national or local standards, not only in the screening and treatment of patients, but also in the education and accreditation of the labor pool, as well as the accreditation of facilities. These safeguards aim to improve diagnoses, increase adherence to well-documented practices, and reduce the incidence of harmful errors. The lack of reliable data on quality, safety, and service can hinder the development and monitoring of the most effective treatments Medical literature provides growing evidence of the efficacy of particular diagnostic and therapeutic protocols that reduce morbidity and mortality. Health care facilities that follow established protocols get higher-quality outcomes. Hospitals with the highest adherence to evidence-based protocols for the treatment of pneumonia, for example, have 20 percent fewer complications and 25 percent fewer readmissions than hospitals with the lowest adherence. However, we found that health care providers in the countries we studied fail routinely to use the available protocols properly. In Germany, for instance, 35 percent of diabetes patients in one survey reported that their annual checkup didn’t include an examination for foot ulcers, one of the normal complications of chronic diabetes. For more about evidence-based management outside of health care, see “Managing your organization by the evidence.” The availabilty of information. Health systems can promote evidence-based medicine by making real-time information on key outcomes and practices freely available to policy makers, insurers, providers, and the public. Studies in the United States have shown differences in quality between health care organizations that issue reports publicly and those that don’t. The mortality rates of cardiac departments in the United Kingdom improved markedly once these rates were published. Risk-based monitoring and audits. Safeguarding quality also requires a comprehensive system to assess the delivery of health care and to recommend intervention for failure or underperformance. National inspection and intervention regimes work best when they allow for both risk-based monitoring (for example, more detailed monitoring of higher-risk organizations) and proportional intervention (no action below specific thresholds, for instance, and heavy intervention in cases of significant concern for the safety of patients). Nonetheless, the most important inspection processes are those of the providers themselves. Leading hospitals build performance reviews into operating meetings, put these reviews on the agendas of key committees, and integrate the reviews into employee assessments