Measuring Things

I recently read Better: A Surgeon's Notes on Performance, a wonderful collection of essays penned by Atul Gawande, a general surgeon and frequent contributor to The New Yorker. I was struck by one passage in particular:

"Regardless of what one ultimately does in medicine - or outside of medicine for that matter - one should be a scientist in this world . In the simplest terms, this means one should count something. The clinician might count the number of patients who develop a particular complication from treatment - or just how many are actually seen on time and how many are made to wait."

How can a hospital improve clinical outcomes without first understanding how its outcomes compare to outcomes at peer institutions? The larger argument is that in any given endeavor - medicine, baseball, farming - there are positive deviants that, by definition, outperform the average. Just as some baseball players consistently bat above the league average, some physicians and some hospitals consistently create superior clinical outcomes. In the case of hospitals, how much could they improve the quality of care delivered if they could identify and emulate positive clinical deviants among other hospitals? Why is the Mayo Clinic more successful at treating pituitary tumors than 95 percent of other U.S. hospitals? What are they doing right?

At the Organization for Economic Cooperation and Development (OECD), a sort of best-practices organization for the world's developed nations, researchers are developing a comprehensive set of healthcare quality indicators that will eventually allow policy makers to compare clinical performance across healthcare systems. The development of metrics for the assessment of clinical quality - breast cancer survival rates, stroke 30-day mortality rates and colorectal cancer screening rates - will help answer important questions. What does the French healthcare system do better than the Spanish healthcare system? Why does it do it better?

I think they're great questions and will hold important lessons for individual institutions and systems.