QI for dummies (But Who’s The Dummy?)

By  |  February 29, 2016 | 

I am reading a continuous barrage of stories on physician burnout.  Over and over and over.  I also see the same causes on which to attribute this burnout.  Over and over and over: 

–Workflow dysfunction. 
–HIT gone bad. 
–Regulatory headaches.
Seems like the scales have tipped and yesteryears favorable practice-happiness equilibrium now goes a little too heavy on the drudge, and a lot less light on the joy.
Here are two little parables.  See if you can connect the dots:


1) A metric that measures how quickly an ER patient gets antibiotics for a urinary tract infection, but fails to measure how accurate the diagnosis was in the first place, is akin to judging a hunter‘s skill by how straight they shoot, and ignoring whether they can tell the difference between a deer and the neighbor’s dog.

2) A long time ago, back when people still filled out expense reports by hand instead of spending three hours trying to get the online expense system to work, a man took a client out for a week on the town. He had a very good week, and at the end of it, he escorted the man out of the restaurant where they’d had lunch to put him in a cab to the airport. Noticing that it was raining, he whipped out an umbrella to protect his customer from the rain. Unfortunately, just as the happy man climbed into the cab, a gust of wind shredded the salesman’s umbrella.

Fret not, the delighted customer gave his firm a huge order. And the salesman duly submitted his expense report for $122.46. At the bottom, he listed “1 Umbrella: $3.99”. (Yes, as I said, it was a very long time ago.)

The next day, his expense report came back via interoffice mail with the umbrella x’d out in red and a note from accounting. “You cannot expense an umbrella” it read. “Please fill out a new report and resubmit.”

Our perplexed salesman sat down and wrote out a helpful note explaining that the umbrella had been lost while sheltering a client during a sales call. Then he laboriously filled out a new expense report for $122.46, with “1 Umbrella: $3.99” again listed at the bottom.

You can probably guess what came back in the interoffice mail the next day. The notes flew back and forth, with increasing degrees of venom. Eventually he got a note written entirely in red pencil that said “I will not approve any expense report with an umbrella on it. Fill out a new expense report without it, or good luck finding a new job.”

The next day accounting got a new expense report for $122.46 and a note appended, also in red pencil, that said “As requested. Good luck finding the umbrella.”

Too opaque?  Nah.  We got lots of  #1.  Soon we gonna get lots of #2.

Credit goes here and here.

One Comment

  1. Aparna Mohan February 29, 2016 at 10:06 pm - Reply

    Very well put.

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About the Author: Brad Flansbaum

Brad Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.


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