Supporting Safer Healthcare

While browsing the Wall Street Journal Health blog this morning I came across this intriguing post: How Quality-of-Care Rules Can Lead Doctors Astray.  It opens with:   

“Rating doctors and hospitals and paying them based on the quality of care they provide can have dangerous consequences — especially when the issue of how to define “quality” is up in the air.”    

That’s the take of Jerome Groopman and Pamela Hartzband, two doctors at Boston’s Beth Israel Deaconess Medical Center.  Dr’s Groopman and Hartzband take an even stronger approach in an article entitled Why Quality Care is Dangerous.   

At first blush that may seem like an oxymoron; isn’t the delivery of quality care a fine goal?  In fact, isn’t it included in most hospital mission statements?  The Wall Street Journal article opens with:   

“The Obama administration is working with Congress to mandate that all Medicare payments be tied to “quality metrics.” But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.”  

Metrics are certainly not evil; measuring compliance, targets, and outcomes can provide insights not otherwise gained.  Peter Pronovist, M.D., Medical Director, Center of Innovations in Quality Patient Care at Johns Hopkins Hospital, made the statement that “without valid measurement tools we believe that we are safer than we are.” 

Metrics are quite the “in” thing in healthcare at the moment.  Most leadership meetings contain a review of various bar charts, line graphs, and scatter diagrams promulgating the organization’s current quality initiatives.  As a database designer I admit to being a contributor to the growing body of healthcare metrics. The results can be enlightening; if, and here’s the rub, the methodology and process for obtaining those metrics is well thought out, well controlled, and based on worthwhile targets.    

The analogy of a bus comes to mind.  When the process of obtaining and reviewing metrics is well designed and managed the results can simultaneously move a large number of people in the right direction. On the other hand, when the process is not so well “driven” the end result may simply be an out-of-control vehicle that advances relentlessly forward, mowing down anyone in its path. Ouch!