How NOT to Measure Healthcare Quality

Guess what? Only 1% of hospitals are below average! At least that’s how chairmen of non-profit hospital Boards of Directors see it. Apparently they live in Garrison Keillor’s Lake Wobegon, where all the children are above average. Patients, well, we live in real towns. If you ever wondered why hospitals were such dangerous places to be, we can now give you a big hint.

Of 722 hospital chairmen surveyed in a Harvard study, 99% thought their hospitals performed as well as average. The scariest finding is that fully 100% of hospital chairmen for hospitals that perform the worst think their hospitals perform at least as well as average or typical hospitals. Ironically, that means the 1% who thought they were below average actually underestimated their hospitals. But that still leaves an incredibly significant number of chairmen who seem to live in an alternate universe.

We know it’s not because quality isn’t being measured. Whether for National Committee for Quality Assurance, Joint Commission, Medicare or a local quality program, hospitals have had entire departments devoted to abstracting quality information for 20 years. The data used to determine actual quality at the dope-smoking chairmen’s hospitals was taken directly from the federal Hospital Compare site, available to the public. No wonder so little has changed since the Institute of Medicine published Crossing the Quality Chasm in 2001.

Hopefully that quality feedback actually does see the light of day within hospitals’ clinical departments, nursing units and specialties. But hope won’t help you or a family member who unwittingly stumbles into one of the below average facilities. So do yourself a favor and check out local hospital scores. Because at the hospitals studied, quality was one of the top two priorities in less than half. It was important in evaluating the CEO’s performance at only 44% of facilities, and quality performance was on the Board agenda of only 63%. Apparently that performance wasn't benchmarked to anything, based on chairman perceptions of quality.

It could just be that these chairmen spend all their time and energy on Planet Financial Balance Sheet – financial performance is consistently on the Board agenda at 93% of the hospitals (not 100%?) Hospital margins are typically 2-3%, and usually operational efficiency and effectiveness are right up there with private insurers’. Waste is a fact of life that leaders aren’t inclined to handle in resistant cultures. So a tough economy can be hard on these folks. Remember, just because they maim and kill you doesn’t mean you won’t be billed a princely sum for it. That’s a 100% guarantee.

Update: A good article today in HealthLeaders Media discusses a key strategy to overcome the "arrogance of excellence" on many hospital boards: confront them with an actual case of severe harm, preferably including a conversation with the patient or a family member of the patient. "The trustees have to become outraged," says the Institute for Healthcare Improvement's James Conway.

Photo http://farm3.static.flickr.com/2203/2484628164_93af0da1e6.jpg // CC BY 2.0