And Speaking of the Unintended Consequences of Quality Measurement…

I must have “you can’t manage what you don’t measure” on the brain – here’s a piece I wrote this week for AHRQ’s Guidelines/Quality Measures Clearinghouses called “Is the Measurement Mandate Diverting the Patient Safety Revolution?” Well, of course it is.

In it, I make the point that our hunger for measurable targets – generally a good thing – automatically diverts us from that which we don’t or can’t measure. In the quality and safety world, this means that we’re spending a lot of time documenting smoking cessation counseling and very little on avoiding transition errors; a huge amount of energy on preventing ventilator-associated pneumonia and precious little on improving teamwork; and, most perniciously, oodles of effort making sure that we complete a group of measurable processes, some of only marginal importance, and almost none on making correct diagnoses. As I wrote in the piece,

…as long as a system or doctor can look good on public reports by giving “pneumonia” patients pneumovax but remain unscrutinized if they misdiagnose half the pneumonia patients, diagnostic errors are likely, in the words of Rodney Dangerfield, to “get no respect.”

Anyway, happy National Patient Safety Week! We’ll get there…

1 Comment

  1. Peter Patterson MD on March 5, 2008 at 3:29 am

    Bob, I don’t think it’s fair to say that measurement is deflecting us from patient safety. It’s axiomatic that we need real data (measurement) rather than just opinion – even expert/experienced opinion – that patient care being given meets good practice standards.

    That aside, you really are onto something with the Yin and Yang idea and I like your composite measure for blood glucose control in critical care units. All metrics for clinical care processes should probably be composite in the sense of integrating measures where maximums-are-best with measures where minimums-are-best, or as you say, where you get points taken off for having to use vitamin K or FFP to correct anticoagulant dosing errors.

    One other major problem with healthcare quality measures – especially so-called core or critical measurements – is that they are often metrics for care processes that don’t exist. They are disconnected from underlying clinical workflows. Then after years of collecting these core measures, we wonder why no improvement has come to pass. Duh, you can’t improve a measure that’s not a real metric for a clinical process.

    Peter Patterson MD

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