Where Do You Stand?
When I was younger I began the sport of running. However, I didn’t do it competitively, I did it just for “fun.” Sometimes I ran to think, and sometimes to stop thinking. Sometimes I ran to get away from people; other times to spend time with other runners. I ran for lots of reasons, but I never ran to win a medal. I didn’t need to win anything or be recognized for my running. I ran strictly for the joy and escape it provided.
A friend of mine who was a competitive athlete used to nudge me from time to time: “you oughta do a race one of these days.” A race? Why? Why did I need to wear a number and have a position or outcome tied to how I did? Why did I need to pay an entry fee to compete when I could run any route I liked for free? Truthfully, part of me didn’t want to know where I would rank. It was easier for me just to run. It was easy to “do my best” and be blissfully unaware of where I stood among my peers. So, for years I did not race.
Then one day, I gave in to the pressure and signed up for my first race. Then I actually showed up and did the run. As I ran, I observed how others around me were doing. And I pushed myself. Positive peer pressure was motivating me. After all, what adult woman wants to be passed in a 10K by a middle schooler? I knew that losing to a kid one-third my age wasn’t a value judgment (it didn’t imply that I was a good or bad person), but it definitely was a bit of a bruiser to my pride. When I saw people who looked about my age and build, I also wondered if they would be able to beat me.
As youth we are carefully taught this culture of not caring to see how we stack up in this performance based world. When my daughter was on the elementary school soccer team, she wasn’t a star player. Now, she’s great at lots of things: she’s clever and beautiful. She’s got a great voice and a beautiful, dramatic spirit. But she is no soccer player. At the end of her first soccer season, all of the kids on her team got trophies complete with the pre-pubescent gold female figure kicking a ball on the top. The trophy was not for an outcome or achievement. There was just one revealing word beneath her name: “Participant.”
Aren’t we in the place where we can stop recognizing everyone just for participation? Why have we become so uncomfortable with having our performance measures seen publicly?
I understand that life can be difficult, and the challenges individuals face can make just showing up seem like a feat some days. I’m not addressing those types of challenges here. I am referencing those who choose not to do the work because they don’t want to, like parents who have turned to cheating on behalf of their kids in order to depict them as more successful and accomplished than they really are (as evidenced by the recent college admissions scandal).
Being in the race gave me a chance to see how I performed as a racer and where I fit in compared to the field. It wasn’t a happy or sad experience, per se; it was an awareness experience. I knew approximately how far I was behind the elite runners and how far I was ahead of the jog/walkers. All good information. At first, I didn’t strive to win or lose, but I did feel pushed out of my comfort zone, which is never a bad thing in the end. This is a feeling I have learned to embrace as I mature. And, I can say without a doubt that after running a race, I always run a little harder those next days and weeks. The friendly competition pushes me to do better than I normally would, which benefits me inside and out.
Having public data and seeing how we stack up professionally can be an awareness experience, too, if we embrace it. What is wrong with challenging ourselves and looking at our daily numbers even when we may not come in first place?
In my world of helping to transform healthcare, I talk often with front-line staff and leaders about data, outcomes, and transparency of data and information. And healthcare is complicated by the fact that most providers are used to being at the top of their class and the smartest in their group. Many hate knowing that they are not at the top in their clinic. This works to further complicate data transparency in the healthcare industry, and since each patient is different, the argument that comparisons cannot be drawn continues to carry weight.
Success comes in different forms and there are many ways to both define and gauge success. As diverse as patients and health centers are, so is their perspective on the culture of data use and data transparency. One or two vocal fans of data transparency cannot single-handedly change the direction of the entire organization or the culture around data. But a data awareness movement is afoot and those who move in that direction will not only address underlying cultural issues; they will also modernize their practice and raise awareness around outcomes.
Let’s take physician performance, for example. Atul Gawande in his book Better (2007), dared to think of a world where patients would choose to go to a physician because the physician produced great outcomes. Imagine going to get prostate surgery from a physician/team that does a dozen prostate surgeries every day. Dare to imagine a world where patients choose to put their health and wellbeing into the hands of someone with a proven track record of surgical success, not just a certification.
This critical review and use of data is exactly what athletes do when they hire a coach who has led other athletes to pro status. It is what musicians and actors do when they look for an agent who has brought others to success. It is what we do when we want a financial advisor or investor who can show by the data a proven track record of return on investment (ROI). Heck, it’s what parents do when they look for a high school (or even pre-school) that has a great track record of producing “successful” kids. We can argue all day about the definitions of success, or the inability to reduce performance to mere numbers, but we know that when we really want people who can deliver the goods, we seek them out, we look to their data to confirm what we hear, and we hire them.
Since the early 2000s there have been threats of upcoming report cards and transparency in healthcare. However, we have not yet reached that point, at least not in a usable, consistent, apples-to-apples form for patients to review. How can you start to change this in your organization?
First, it’s difficult to judge doctors by the quality of their patients. If all patients, similar to all 10Km race courses, were created equal (which not all 10K runs are, but at least they all equal 10k despite uphill, downhills, or no hills), then maybe that would be a fairer measure. Given that genetic factors are often unknown, social determinants of health are difficult to quantify, patient “compliance” is variable, and patients ultimately make health decisions all day long as part of their lifestyle choices, it hardly seems fair to judge physicians on the quality of their outcomes.
Or does it?
In some slow but subtle ways, this is the direction that healthcare is moving–to Value Based Payment (VBP). This VBP system rewards those who perform via their quality measures. It doesn’t, however, reward based upon the result of the pap smear (screening for cervical cancer screening). It rewards based upon whether the test was done in a timely manner, and if the results were followed up on appropriately. Depression quality metrics don’t judge a physician for having a more depressed panel of patients; these metrics only reward for the percentage of screenings done to catch depression early and treat it.
In many health centers, members of the quality team have begun to post quality measures on a bulletin board in places where staff can easily see how their team is performing. However, what I am still surprised by, is that despite the increased accuracy of data (it’s still not perfect, but it’s better than pulling random paper charts and flipping through them in order to complete paper audit forms), we still tend to view data anonymously. This is something we can start to change now. For example, we currently don’t like to name outcomes and publicly share that Dr. X has a lower rate of filled appointment slots or has a failing rate of colonoscopies completed for patients. Yet we can begin to subtly move away from anonymity and raise awareness.
Going forward, we can begin to use data to not just reward providers or care teams as key participants in this healthcare work we do, but we can transparently share data with the world. Using data to show everyone where they stand can be used to raise awareness around outcomes and positively push us to a higher level of performance. True data ownership belongs to the care team and allows us to drive our team-based care forward in ways that really make a difference.
Once that happens, we can begin to leverage the entire patient care team in order to reach patients and better meet their needs while proving what rock stars we are when we do it!