How Do You Measure Quality in Health Care?

As someone who leads an integrated health care delivery system, this is a question I frequently find myself asking.

The obvious answer, of course, is to develop measurements based on treatment protocols. Of which we have plenty. It seems these days that we have a measurement and documentation requirement for just about everything. In fact, quality measurement in health care has become an industry unto itself. Hospitals and health care systems across the country pay a lot of money to have their quality of care scrutinized and, hopefully, lauded, by a number of companies that charge them for such assessments. In many cases, those assessments are valuable.

Nevertheless, I began to think about the value of measurement after exchanging some emails with my friend and college mentor, Deborah Stone. Deborah is a professor at Brandeis University’s Heller School for Social Policy and Management who’s been doing a lot of thinking lately about counting, measurement, and statistic and the ways in which numbers are used to distort and distract from reality. In a lecture she recently gave to the American Political Science Association, Deborah announced to her audience, “Numbers are figments of our imagination, fictions really, no more true than poems or drawings. In this sense, all statistics are lies.”

I’m not sure I’m willing to go as far as Deborah, who’s quite a provocative thinker, but she did make me wonder whether our current health quality measures are offering the right information and, moreover, whether everything valuable in health care can be easily measured. At some level, I suspect, things that are important are not always quantifiable. For example, even if my facilities are spotless and my clinical staff is expert at avoiding preventable infections, does that mean they’re good at explaining diagnoses to their patients? Do they know how to communicate effectively and sympathetically when delivering bad news? Do they return patient calls at night? In today’s health care climate, physicians are often required to see a specific number of patients each day. But how effective are our measurements if a physician misses that quota because she devoted extra time to a single patient who really needed the extra attention and care?

The full Forbes article can be viewed at this link.