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…
About the Author: Bob Wachter
Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine.
He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google.
His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.
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