It would seem logical that newly-minted physicians entering the medical workplace would expect that some level of performance monitoring would apply. However, this complex and ever-changing world of hospital and physician performance measurement often makes the young medical practitioner apprehensive and questioning.
Are such measurements in the context of pay-for-performance (or non-performance), or in a quality improvement and educational context? How are physicians being measured? And is the data that is being used for measurement trustworthy? Let’s examine some of the issues surrounding physician performance measurement and how technology can help create a more trustworthy measurement environment.
Why physicians resist performance measurement
There are many complex issues that encumber physician performance measurement. Many physicians fear that inherent mountains of box-checking paperwork will interfere with their ability to practice efficiently. Proponents of performance measuring argue that financial incentives for improving performance will ultimately improve care and lower costs. Opponents, on the other hand, believe that it can place an undue burden on professionals with little foreseeable gain over the short range.
Many healthcare practitioners are motivated to enter a healing profession by a feeling of altruism. If business-like efforts to measure and improve quality negate that feeling, the high burnout rate of medical personnel may become even higher.
Hospital managers must pay careful attention to how performance measurements are viewed by staff. Negative staff views can proliferate and subconsciously affect practitioner opinions and attitude. It is imperative to train young physicians to attain a basic understanding of the purpose and rewards of performance measurement and work with the system rather than around it.
Information retrieval and performance monitoring have already shown advantages, especially in hospital settings. While performance measurement is here to stay, it must be flexible enough to allow constant tweaking by both staff and management.
Challenges faced by physicians
Most performance measurement information currently in databases is at the level of hospitals or multiple doctor medical groups or practices. Thus, the singular practitioner is at a disadvantage that may affect his or her rating with government systems like Medicare or various insurance groups. This is because it is difficult for an individual physician to have an adequate sample size. A sole physician simply does not have a sufficient number of patients with the target condition to present a valid measure.
In a practice group or hospital setting, physicians are wary that the overall grade of the group may inadvertently be assigned to them, even though they may be performing at a much higher level. This can lead to distrust. However, many doctors are competitive by nature. Open performance and grading systems may help eliminate fears and get a team working more like a team and less like individuals.
Legitimate accountability should involve measures that are available to the health care workers themselves as well as to the public. By itself, this can foster improvement.
Challenges faced by hospital management
One of the most serious challenges to hospital and organizational management is getting both clinical and administrative staff on board with the implementation of new systems, especially those that measure performance. It is important for management to make all people understand and feel connected to the administration’s vision of how new systems will benefit both employees and patients.
Physicians need to be given assurances that quality patient care is what matters. They do not need their time wasted by their own administration or repetitive metrics from insurance or other healthcare organizations. They need to be confident that the metrics they provide will not be used as penalties or false incentives.
Similarly, those responsible for definitions need to select meaningful metrics that do not routinely waste time forcing medical personnel to make repetitive entries.
How hospitals and physicians can work together
According to several studies, physician burnout rates for are more than 50%. Many believe this is due to the high volume of surveys, insurance forms, and other paperwork physicians are forced to deal with on an everyday basis.
Hospital survey data is part of this paperwork blitz. Working with all staff members as well as physicians can make this burden less intrusive and/or wasteful. Incoming and discharge patient surveys are often repetitive and waste time for both patient and staff without providing much new or important data.
Technology can help by providing administrators and managers a way to identify and adjust for specific areas with opportunities for improvement at all levels. But the only way to understand if poor performance by staff or inherent other issues in the system contribute to the outcome is to construct surveys that ask meaningful rather than “rote” questions.
Well-designed software can help. The best answers arise when well-written survey data is analyzed by well-designed independent software. Data can be analyzed in real time and negative trends can be identified and corrected. Software can make analytics easily accessible and usable for everyone within an organization without a need for additional data or report writing.
It is important that physicians trust the data presented by the software if they are to be motivated to change. It is also critical for the software to present analysis from summary metrics to underlying details down to the patient encounter level.
Well-designed software can help meet Joint Commission reporting requirements as well as help detect performance issues quickly. Extensive data filtering by visit type, care setting, and relationship to patient helps ensure objectivity during reviews to better motivate physician improvements.
Powerful software can provide hospital managers with a streamlined ability to identify specific improvement opportunities at the organizational, as well as many sub-levels. By integrating up-to-date metrics from existing repositories, including clinical, operational, and financial, well-designed analytic software can do more than analyze performance, it can make everyone′s job easier and more effective.
Click here to learn more about Dimensional Insight’s Provider Advisor application for physician performance measurement. The application comes with out-of-the-box measures that can be quickly implemented in your hospital.
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