Time Talent and Treasure to Measure Is Not Quality

Behaviors, situations, relationships, environments, social determinants, and other people factors shape education, health, economic, and societal outcomes. You don't change people or people factors by testing focus. You change people factors by investing in people change.

People Are So Much More Than What Can Be Measured
Our "intellectual" leadership has promoted measurement schemes that have failed to address outcomes. They have forced governments, schools, and health care providers to invest in measurement in ways that steal the dollars needed to invest in the professionals to facilitate behavior change. This is the lazy and ineffective choice that has been incredibly costly and distracting. Most of all humans are far too complex to be captured in measures. Adding more measures in more dimensions and with higher technology processing is a waste of time, talent, and treasure.

Even in arguably the best measurement scheme (NY CABG), it is not possible to discern an individual surgeon from the average 80% of the time in the best case scenario. This is also the rare best of situations scenario when you actually can assign surgeon to the procedure to the outcome.
Misguided Federal Measurements in Health and in Education 
Trying to measure the outcomes of other physicians and hospitals is ridiculous, costly, and a distraction from care. Patient factors are 60 - 70% of outcomes, then there are unknown factors, and genetics, and finally a small fraction (perhaps 10%) that can be influenced by clinical means. The digital approaches costing hundreds of billions more are focused on the smallest influence and are further diminished by being a small portion of that small portion. In other words, there are 3 or 4 other influences that render digital measurements obsolete. It is actually difficult to see any relationship in the variables - other than lesser outcomes from people factors. This is why schools, teachers, practices, and hospitals that provide services for less advantaged people consistently.

Now turn to teachers working with 20 - 30 children (multiply the complexity by many times) whose lives are shaped largely by the years before (before birth to previous year) and shaped predominantly by outside influences. We already know that the highest property value school districts have lowest performing children that have better outcomes than the lowest property value school districts. And we have performance gurus that are trying to measure the teacher? 
Attempts to change children are even more difficult after age 9 due to a decrease in the velocity of learning. Best attempts involve the earliest months and years of life, long before measurement begins. Measurement actually segments children into environments that limit the ability to change their situations, employments, and more. 

The time, talent, and treasure to measure 
  • also takes away teacher, assistant, or team member time to interact with students and parents while 
  • cutting (redirecting) funding for assistants and colleagues that can maximize interactions while
  • taking away classroom time for interactions for test prep and test taking while
  • distracting
Discrimination By Design 
The recent changes to send less dollars where dollars and people investments are most needed is discrimination by design. This only magnifies the inequities of too much health and education spending in too few places leaving most Americans behind by design.

We must stop the lunacy of quality measurement. Humans are far too complex for "the best and brightest" to attempt to measure. The early designers of "intelligence testing" documented this fact true from 1920 to 2020. All that they have is a hammer and they are beating up health and education team members. Those who oppose such lunacy are not opposed to quality. They are opposed to the lack of evidence basis. They are tired of the lies. They are focused on investments in people.

Why do we tolerate stagnant to declining payment with even less invested in team members (due to quality measurement costs) with even less productivity (due to measurement) and with less time for meaningful interactions. This is the formula that is accelerating burnout in health and education and destroying access to primary care and mental health.

People change to make our nation more efficient and effective is about investing in the people to facilitate behavior, situation, environment, and other people factor changes. 

Time, Talent, and Treasure Down the EHR Drain

Observational studies now document the obvious. Physicians are required to spend 2 hours on EHR for every hour spent in patient care. The digital delusion has distorted doctors from their duties.  And this is only the beginning...


No Positive Spin for the Innovator Tailspin - more claims for innovation successes are apparently attempts to hide failure
Stop the Promotion To Restore Mental Health Access - claims of mental health care reforms or improvements are a stark contrast from the reality of lowest payment, highest complexity of care, unreliable payment, and poor support other than lots of rhetoric

Primary care can be recovered and should be recovered, 
but cannot be recovered when moving the wrong directions

Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2016


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