The Dilemma of Measurement in Healthcare

Those of us who clocked enough time in healthcare know that whenever we get to a discussion on indicators ranging from aspects of quality, operational effectiveness, financials or even workload, the debate can be quite interesting, to say the least.

This is not surprising because healthcare, quite unlike manufacturing processes, has its product (ie the patient) as a variable. Two human beings with seemingly similar medical conditions may have symptoms that manifest differently due to different genetic makeup, different environmental factors and different predispositions. Treatment may thus produce different results, take different amount of time and may require different level of intensities. Even modalities and medication can vary. Such differences, as it is commonly argued, will affect quality, render operational processes less effective, consume different amount of resources and hence different financials and quite different outcome. So, the "natural" conclusion is that measurement in healthcare is not ideal and may not produce the kind of insights and improvement that we see in other industries.

The truth is somewhere in between. At the case level, the arguements set forth above are true. However, when we adopt a "population"/ statistical approach, one will NOT find it difficult to discover that there are lots more similarity among patients than we make it out to be. We can develop insights for improvement when we measure, and are courageous enough to test ideas for improvement that those insights suggest. Often, this distinguishes between the great healthcare organisations and those that are mediocre.

Paul Levy, the CEO of a Boston academic medical centre, wrote in his latest log entry "relentless determination" that healthcare organisations often get carried away with the notion that the science to measurement in healthcare is imperfect and let themselves live with arbitrary sense of security that they are providing healthcare as best as they can. It is only when we measure that we will soon find out that nothing is further than the truth.

When we are not careful, we soon find ourselves confronted with the "dilemma of measurement in healthcare"...damned you do, damned you don't! In such cases, only courageous and strong leadership counts.

The next time when we have the occasion to discuss an indicator, learn to refrain from asking what's wrong with this indicator. Instead, ask what is right about this indicator that can help me make better decision. When we seek, we inevitably find.