Medical care delivery.

Abstract

A recent CMAJ lead editorial notes that failures to manage patients according to widely accepted standards of care may be more common than the medical errors that result in serious adverse events in Canadian hospitals.1 The editorial goes on to suggest that “process-of-care standards could be implemented in hospital and ambulatory practice; adherence could be monitored and the results disclosed.”1 In BC we have established many standards of care through our clinical practice guidelines and we monitor adherence to many of them through administrative data. We can easily confirm your suspicion concerning the prevalence of failures to manage patients according to accepted standards of care.2 I am dismayed that you feel that public disclosure of the results of such monitoring will push physicians to improve their scores. This approach is rooted in the culture of blame that bedevils our health system and that so often leads to selective reporting, gaming, concealment and lack of cooperation with otherwise promising quality improvement initiatives. Measurement should be for learning, not for judgment. In BC we offer software that provides doctors with their performance measures in the privacy of their own office. I believe this creates a safe environment where doctors can learn to improve the care they provide and that making the results public would detract from this process. G. Howard Platt Director Medical Outcomes Improvement Branch British Columbia Ministry of Health Victoria, BC