(Re-)humanizing the datadriven world of healthcare
By Jonathan Breslin
embers of the public would be pleased to know that our hospitals expend significant resources (financial and human) on quality improvement. Reports like the Institute of Medicine’s ground-breaking 1999 report, To Err is Human, have made those who work in healthcare painfully aware of just how much work is needed to improve the quality of the care provided. Many hospitals have quality improvement departments, or at least people on staff who are trained in quality improvement methodologies. More recently there has been a movement towards creating cultures of quality improvement in organizations, to encourage and empower employees and physicians to lead quality improvement efforts right at the point of clinical care. This is obviously a good thing. A natural question that follows is, “How do we know if we are successful at actually improving quality?” The obvious answer is to find ways of measuring it. Thus we have quality and performance indicators: wait times data, infection rates, falls rates, critical incident data, and an endless list of acronyms like ALC, HSMR, EDLOS, and so on.
The more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators. Senior leaders and Board governors devote countless hours to monitoring and discussing their hospital’s performance on each of the indicators, typically via a balanced scorecard: a document that contains a dizzying array of numbers and trend indicators, such as arrows pointing in different directions and colour codes (green is good, red is not good). Hospitals are now held both publicly and fiscally accountable for their performance – certain indicators are publicly reportable, and hospitals (as well as individual senior executives) can be penalized financially for not meeting certain targets. In theory, all of this is a good thing. But there is a drawback to the emphasis on data and indicators in the health care world: it de-humanizes what is at its heart a very human endeavour – the provision of care to people in need. Even the part of quality that is more inherently human – the patient experience – gets reduced to indicators on a balanced scorecard, by tracking data related to complaints or concerns, for example. The problem is the more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators. Patients lose their individuality, their human-ness, and instead become faceless numbers in a spreadsheet and balanced scorecard. The tangible risk here is that we are psychologically less motivated by data than we are by individual stories. As Mother Theresa once said, “If I look at the mass I will never act. If I look at the one, I will.” www.hospitalnews.com
Many leaders in healthcare have begun to recognize this and have introduced various strategies to re-humanize health care quality. For example, I have heard of hospitals that begin Board meetings with the sharing of a patient story to set the tone from the beginning that the hospital’s work is about the people it serves. There is also a new movement in hospitals to create Patient and Family Advisory Councils (PFACs) to
integrate the patient perspective into hospital planning and decision making, and there is great potential for these councils to further re-humanize healthcare. If utilized properly these PFACs can help us see everything we do through the eyes of our patients, from building and renovating our facilities to developing policies. I recently read that Thunder Bay Regional Health Sciences Centre has even taken the step
of inviting one of their PFAC members to join their Quality of Care Committee. What better way to re-humanize the hospital quality agenda than to have an actual patient or patient’s family member sitting at H the Quality table? ■ Jonathan Breslin, PhD is an Ethicist at Southlake Regional Health Centre and Mackenzie Health.
YOUR ADVANTAGE, in and out of the courtroom.
NOVEMBER 2015 HOSPITAL NEWS
Technology in Healthcare, Patient Experience & Hospital Performance Indicators. Special MEDEC Annual Supplement.