Are we collapsing yet? Over-measurement is part of the hemorrhage in healthcare delivery

Aug. 19, 2019 / By L. Gordon Moore, MD

It should come as a surprise to no one that healthcare providers are frustrated (a significant understatement) by all of the requirements around documentation of their work with patients.

I hear from nurses and doctors in emergency rooms, ICUs, regular care units, outpatient clinics and office practices that their work hours continue to expand while their care hours—time actually spent with people who need care—are shrinking.

Colleagues and I crunched some data for a hospital recently and found (again not surprisingly) that almost every care unit we looked at was seriously understaffed compared to the average patient census. The horrible thing is that this particular hospital desperately needs to cut costs or their very survival may be at risk.

The hospital was able to create process improvement plans that should reduce time spent on unnecessary work, meaning less time would be spent trying to stuff patients into over-crowded units and more time would be spent mobilizing patients to improve their chances of going home on time and successfully managing their health.  But what concerns me is the amount of time and effort the doctors and nurses spend laboriously documenting care delivery instead of actually delivering care.

We should look at this issue of quantophrenia (over-measurement) as one of the root causes. Our desire to understand the quality of care has led to an explosion of quality metrics mostly focused on processes of care delivery. This necessitates careful documentation of process which in turn aggregates into our lived reality of ever-increasing costs coupled with less-than-ideal outcomes and declining satisfaction for patients and caregivers alike.

We’ve gone too far. It’s time to rethink this approach, step back and think about what really matters. If we want better health care at a more reasonable cost, we can start by questioning the value of this quantophrenic strategy. We could step back and consider shifting our focus to big outcomes like the rate of emergency room visits or hospitalizations that are potentially preventable.

Listen to Dr. John H. Wasson describe decades of his work on measuring what matters and our problem with quantophrenia.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.

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