“In God We Trust; All Others Bring Data”

Abstract

INCREASINGLY, HEALTHCARE PROFESSIONALS are being asked not only to explain why they do what they do but also to provide data that demonstrate that their processes are stable and capable of meeting customer expectations. The move away from absolute trust in the medical system and the providers of care to a perspective that demands data as proof of quality and safety represents a fundamental shift in how this nation views the healthcare industry. Dr. Deming's well-known statement seems apropos to this growing focus on healthcare measurement: God we trust; others bring data! The authors of the lead articles in this issue have a very clear and deep understanding of the growing demands for data being placed on healthcare providers. The article by Patrice Spath offers a wonderful framework for understanding the context and evolution of the national movement toward greater data transparency. There is no doubt that organizations such as the Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and even the Agency for Healthcare Research and have set the national stage for a focus on healthcare measurement. If providers had to respond only to these national initiatives, however, they might be able to tame the measurement monster. But this is not the case. A majority of the data demands currently placed on healthcare providers seem to stem not so much from the national organizations that have been engaged in this work for several decades but rather from the growing number of regional, state, and local agencies and organizations that have decided to place their own data requirements on the healthcare industry. For example, in Pennsylvania, the state data commission (the Pennsylvania Health Care Cost Containment Council [PHC4]) has existed since the mid-igSos, yet several years ago, a new piece of legislation (Act 13 of 2002) established the Pennsylvania Patient Safety Authority (PPSA). This independent state agency, according to its website, is charged with, taking steps to reduce and eliminate medical errors. To accomplish this purpose the PPSA is requiring all Pennsylvania-licensed hospitals, ambulatory surgical facilities, birthing centers and certain abortion facilities to report what the Act defines as 'serious events' and 'incidents' to the Patient Safety Authority. In turn, the Authority will analyze the collected data to identify trends or systems failures that can be corrected to prevent future serious events and incidents. Make no mistake about it, the PPSA is certainly setting the proper tone for patient safely within Pennsylvania. But when you combine the data requirements of the PPSA with those of the PHC4, and then top it off with CMS, Joint Commission, and a variety of purchaser requirements, you start to get a dear sense of the measurement monster's true size and appetite for data. Although the historical review is valuable for addressing Spam's first recommendation for taming the measurement monster (i.e., getting administrative to understand the measurement evolution and driving forces), it is her second suggestion that is the most critical. Specifically, she recommends that leaders must be personally involved in identifying appropriate measures to gauge individual and organizational practices and supporting efforts to develop and sustain organizational capacity for continual performance improvement. As I read her perspectives on this second point, I found myself reflecting on yet another of Dr. Deming's classic lines: Quality begins with intent, which is fixed by management (Deming 1992, 5). If the of an organization do not become actively involved in the quality measurement journey, then they will most likely find themselves at a destination that was not on their initial road map. Obviously, the details of data collection and analysis should not be part of a senior leader's daily work, but setting the strategic direction and forming the organization's measurement philosophy should be the guiding points for senior leaders. …