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Healthcare Information Management: Means Not Ends

The following guest blog post comes from our newest board member, Dr.Tim Porter-O’Grady.  Given the historical vote in Congress last night, coupled with the rising call for evidence-based medicine, Tim’s perspective from the trenches is very timely.  You can also read Tim’s recent article in Nurse Leader magazine on the case for clinical nurse leaders in the 21st century.

One of the big challenges with leaders and clinicians these days is the overwhelming amount of data that must be collected, codified, generated, and analyzed. A big temptation in this necessary effort is to watch data management convert from means to ends. As I travel around the country working with a wide variety of health care agencies, I see clinicians overwhelmed with trying to balance the collection and management of data with the demands of patient care. While data is important, leaders must remember that clinical and management data should be directed to supporting, improving, and advancing patient care not simply a nonaligned means of the measure of process.

When the demand for measurement becomes overwhelming, it moves from tool to goal. When data becomes a goal it moves from facilitator of practice to an impediment to work. In fact, it begins to undo its very purpose and itself become a “workaround” and just another barrier to effective patient care. For many clinical leaders the demand for information and the urge to collect and provide it becomes more important than the real sustainable achievement of value or outcome. One wonders how many clinicians are now working to instrumentation measures, making those measures their performance goals, losing focus on their patient in the process. While the collection of this data is certainly essential to the methods and techniques essential to measuring the presence of effective process, they are indicators, not results.

It must be remembered, in the midst of all this data collection, that clinicians are providing a service deeply embedded in the context for caring to persons experiencing one of the most significantly vulnerable points in their life’s journey. These patients are expecting that the focus, attention, and center of clinical activity are directed to helping them cope, respond, and accommodate their healing journey. The real value-driven measures are those that well articulate a goodness-of-fit between the needs for caring and the resources necessary to assure that it occurs efficiently and effectively.

The best measure of the utility of data is that which assures that mission, purpose, resources and care interface in a mosaic where the patient expresses exuberance with their experience, the clinician expresses satisfaction with her or his impact and management recognizes value in the efficiencies leading to sustainable outcomes. The achievement of these ends is reflected in the essential dance between the stakeholders and the organization and the music is the information that demonstrates their convergence.

So, finally, it is important for each stakeholder to both recognize and enumerate value in the collection and analysis of data related to the dynamic of caring for patients. Equally important is to acknowledge that data is reflective of value and action, it is not, however, itself value and action. Measurement of the meaningful delivery of service is not the service itself but, rather, is indication of the effectiveness and efficacy of the service. There are three things that must continuously be kept in mind when interfacing data management with clinical care:

  • The ownership for the output of care is always the clinician at the point of service. Transferring that ownership to other points in the organization does not increase personal accountability and does nothing to either facilitate or advance the outcomes and impact of that service. In fact, shifting this locus-of-control from the point of service only impedes the achievement of sustainable value.
  • Data collection and analysis can only serve to inform work and effort; information is not itself the work — it remains forever means not ends. When information becomes the point of work, the real value of that work is lost and its purposes becomes skewed, making it increasingly difficult to recalibrate people and organizations toward who and what they are and do.
  • Clinical leaders must increase both their acceptance and their use of data in the determination of objective and meaningful value in the critical clinical work they do. The meaningful use of information should relate directly back to the point of service and the creation of real value. Through the good use of the means of data collection and analysis, clinicians are empowered to demonstrate genuine value and impact and to make their contribution clear and evident to all.

In the final analysis, sound relationships are the best indicators of both efficacy and meaning. The relationships between health organizations and their clinicians, between clinicians and those they serve, and between health organizations and their communities are the clearest indicators of effectiveness. Data and measurement devices are the lenses through which the value and impact of these relationships can be assessed for both their quality and effectiveness. If all stakeholders in this dynamic keep focused on the ends of advancing the health of those we serve, the data means we use will provide the evidence we need for the validation we seek in fulfilling the central purpose of the caring we provide. Quite frankly, that is why we are here.

March Retail Labor Index

The March release of the Kronos Retail Labor Index reveals that in February 2010 both applications and hires decreased over January 2010 levels on a seasonally adjusted basis.  The decrease in applications slightly outweighed the decrease in hires, so that the Index rose from 3.20% to 3.26%.  This means that for every 100 applications received, 3.26 hires occurred in February.

One developing trend is the increasing volatility of application levels.  The past few months have seen significant swings in application volumes, with increases in September and October followed by large decreases in November and December, and then a significant 20% month-to-month increase in January.

Currently, job applicants are forced to make employment decisions in an environment of extreme uncertainty about a job market recovery.  In this uncertain environment, positive economic news (such as a better-than-expected holiday sales season) will encourage new entrants to the job market – both those wishing to change jobs, as well as those who are out of work but who had stopped looking for work.  In the absence of sustained additional hiring by employers, these application surges will have limited durability.  We would not be surprised to see this volatility continue well into 2010.

I’ll take some flies with that…

I recently attended the Net Promoter Conference in New York City and had the pleasure of hearing Director of Customer Service Tom Graves and CEO Jim Parrish of Carolina Biological Supply talk about how they’ve grown their business by investing in the skills of their frontline workers.  Carolina supplies college and high school science departments with the equipment and organisms they require to equip their laboratories.

Their story is a great case study for organizations seeking to grow the loyalty of their customers through improving the experience delivered by the employees who interact with those customers on a daily basis.  Carolina achieved success by explicitly measuring their customers’ experience, sharing that customer feedback with employees, and providing training to those employees to enable them to better meet their customers’ expectations.  Although many organizations undertake similar customer loyalty programs, the extent to which Carolina has involved their customer service reps in driving improved results is unique.

I recently interviewed Tom Graves in order to share the Carolina story with you.  You can listen to a podcast of our discussion here.

In this discussion, you’ll hear Tom refer to “NPS”.  This stands for Net Promoter Score, a widely used measure of customer loyalty.  You can learn more about NPS here.


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