Counting Quality?

“Not everything that can be counted counts, and not everything that counts can be counted.”Quality

–Albert Einstein

There’s been much talk about hospital quality in recent years.  We measure and report more and more metrics, as each new piece of healthcare legislation comes with new reporting requirements. We’re constantly measuring care data, but in many ways, we’re still far from where we need to be.

It seems we have a tough time determining what we should be measuring. What numbers really matter? Hospitals report metrics – but often disagree with the metrics or how they’re calculated.  Patients judge healthcare organizations through a totally different lens.

A clear example of this appeared in Friday’s USA Today. USA Today compared top-rated hospitals, according to the new HCAHPS survey of patient experience, with Medicare mortality data from www.hospitalcompare.hhs.gov. Top ranks from the patient experience survey were often at odds with top ranks from the mortality data survey.  Patients often liked hospitals that had mediocre or even poor outcomes and vice versa.

So this leads to a single fundamental question: what is quality?

I’ve made the case in the past that, for patients, quality is about what they experience. If patients could assess the clinical competency of their doctors, then they wouldn’t need doctors…they would be doctors.

Providing excellent care is very, very important. It just doesn’t mean the same thing to every organization or every audience.

To patients, quality is about the attention they receive from the receptionist, the bedside manner of the physician, and how long they’re forced to wait. They have no personal reference point with the statistical probabilities that represent our official view of quality. A one percent shift in mortality rates may be statistically significant, but it isn’t meaningful to most health consumers.

So, what does this mean for how we communicate quality?

Your organization needs to determine how it defines quality. This is not the same as rationalizing your current quality situation. Is quality strictly a set of metrics, or is it the institutional knowledge that results from performing volumes of particular procedures? Is your mortality rate most important or do you handle the most complex procedures on the sickest patients?

Patients, the media and job-seeking physicians look at your numbers when evaluating your organization. So when you present your quality metrics, be sure to give them context. What does five percent actually mean? It is good or bad? Increasing or decreasing? If you’re not happy with the number, how are you addressing the issue? All of this helps your audience judge the care system you have in place.

Your website provides the opportunity to tell your quality story. But keep in mind – the numbers aren’t the story.  They are the facts that support the narrative. You still need the narrative.

Most of all, present the information where it matters – connected with the appropriate services. If you have a compelling quality story, be sure consumers find it when they’re evaluating you as a care option.  In the end, that’s what counts.

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