Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Can we measure quality?
27 Jul2009
No, we can judge quality, not measure it. You cannot measure something that has both objective and subjective components.
A reader wrote:
Tell us, please: since Onora O’Neill is such an unquestionable source of Truth, what solution does she suggest? Implicit quality review? Kudos, if that’s the case! (if only we could realign payment rules to support implicit review activities)
I doubt she supports a state of blissful ignorance or believes there are no deficiencies in the quality of care delivered to patients.
First, I recommend to this reader that he/she spend some time browsing and reading this blog. I have written extensively on this question. However, I can try once again.
The problem with assessing quality is the multidimensionality of quality. If we only measure that which one can easily measure, then we will have clear and logical negative externalities. Onora O’Neill argues (as a philosopher) that only expert professionsals can judge and evaluate a professional.
We know that performance measurement can distort physician practice. I have recently written about the many performance measurement problems that we have recently encountered.
So I ask the commenter to consider what the the parameters of quality? We need correct diagnoses. We need decision making under conditions of uncertainty – especially when evidence does not guide us. We need to have physicians who care for patients – explaining diagnoses, the rationale behind tests, the reason and need for lifestyle changes, and delivering bad news. I have not completely described quality. Can you measure all those things?
I do not believe that we can easily measure quality. First, I would like a payment system that encourages true quality – which takes time – rather than one that discourages thinking and quality. We need patient centered care rather than check-box care. We need to rediscover the caring in patient care.
Related posts:
- Measurement – the good and bad
- What is quality – a reader asks
- How to insure quality
- Safety rather than quality
- Being a must read blog
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- In: Medical Rants
6 Responses to Can we measure quality?
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Claudia Rutherford PhD
July 27th, 2009 at 11:36 am
I couldn’t agree with you more. As a clinical psychologist I am always questioning how quality of care can be measured in a quantifiable manner, as so many people suggest doing. Certainly in mental health treatment, this is not an easy thing to do and you can argue that given the chronicity of some people’s illnesses, you are measuring a moving target. Every quality of care measure I have seen has been wildly reductionist and does not seem to really reflect an understanding of what mental health care entails. I am sure the same is true with medicine. I really enjoy your blog, thank you for always being thought-provoking and forthright.
Jan Krouwer
July 28th, 2009 at 5:17 am
I think you first have to define what you mean by quality. You have previously distinguished “safety” from “quality” and I think you agree that one can easily measure (medical) error rates – which you call safety.
Performance measures, however bad and irrelevant can still be measured.
Here is the American Society for Quality definition: A subjective term for which each person or sector has its own definition. In technical usage, quality can have two meanings: 1. the characteristics of a product or service that bear on its ability to satisfy stated or implied needs; 2. a product or service free of deficiencies. According to Joseph Juran, quality means “fitness for use;” according to Philip Crosby, it means “conformance to requirements.”
curious
July 31st, 2009 at 7:12 pm
So after all that, both you and O’Niell favor implicit quality measurement (which you call “judging”…fine). Why didn’t you just say so in the first place?
If you’ll do a little background reading on the distinction between implicit and explicit quality measurement, you’ll see that there’s nothing new under the sun. Or on your blog. You might also learn a thing or two about the inherent problems of implicit quality measurement.