How Much Should We Measure in Hospital Quality?

Why some of the leading pundits have it all wrong

OMW! Here we go again. Yesterday in an editorial on, Don Berwick is quoted as stating at the IHI National Forum in December 2015, that we should “cut in half all metrics currently being used and then cut them in half again.”

I wholeheartedly disagree. And here is why.

Clinical Dashboard – Hemorrhagic Stroke

Ischemic Stroke DB Pt 1

Ask yourself this, does your CFO report financial performance on less than 100 percent of the departments in your hospital? Of course not. They simply couldn’t run the business side of their organizations without information on all facets of their enterprise—every department and every service line. So why should you settle for quality reports on anything less than 100 percent of the patients you treat? I don’t believe you should.

A Practical Example

Let’s look at a practical example. Let’s say that Organization A only has quality metrics for the patients being treated for AMI, CHF, and pneumonia. This means that if a patient has anything other than these three conditions, we would have to say to the patient:

“We’re sorry, but we have no idea how we perform on the procedure you’re having. We can’t tell you if our doctors use the indicated treatments, what your risk will be for getting one, or several, complications, your chance of being readmitted, or what your risk is for dying from this procedure. But we do know from the literature, that your risk of dying in general could be 2 percent or well past 12 percent, but we can’t tell you what your risk is with us. But ‘trust us’ we have some great doctors, we just can’t prove it.”

This is the current state of quality reporting in the United States. This is not acceptable and it’s why I get frustrated when someone says we should only have a handful of quality measures. We should greatly expand our measurement of patient outcomes to a level that informs us about our performance on every patient who comes through out doors. And the data to do this already rests in a typical community hospital’s administrative/finance/cost accounting databases. It’s just waiting to be put into a form that’s meaningful and easy to interpret – a clinical dashboard.

Financial Reporting Versus Quality Reporting

The problem I see is this: we can report our financial performance for every part of our organization and even report satisfaction for every department and service line. But we can’t tell every patient what their risk is for getting complications, being readmitted, or their risk of dying. Without reporting on as many quality measures as possible, the most important part of their care—the outcome—is just an estimation. We can tell you how happy they are at our facility, but we can’t tell you their chances for surviving a procedure.

Quality reporting is as important as the financial reporting, and takes less than an hour each month to review the dashboards for a typical department or service line. No time at all compared to the time spent caring for the patients who have complications or are readmitted when we could have prevented those problems in the first place.

Clinical Dashboard – Ischemic Stroke

Hem Stroke

The Plain and Simple Truth

Here’s the plain and simple truth: My team and I can walk into any organization today, and in less than six months put over thirty clinical dashboards into monthly production, with physician-level drill downs, with the data severity and risk adjusted, and each measure trended over the past twenty-four months. I’ve done it time and again for the past 20 years.

You’ll have to throw some resources at it, but certainly no where near the amount that you already use to maintain and report your financial performance. These thirty dashboards will report the outcomes of care for 70 to 80 percent of your patient population in the typical 300 bed hospital. They will also tell you how much physician-to-physician variation exists, and if your physicians are practicing medicine according to the most current literature (evidence-based medicine).

What You Can Do

Give it a try. You will be surprised at how easy it can be! I’ve included are a couple of dashboards to get everyone started. There is one for ischemic stroke and one for hemorrhagic stroke. You’ll see that they have been designed to report hospital and hospitalist group performance, but you can also use them to report physician level information.