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Finally read this from @jmichaelmcw in @nejmcatalyst
For those of us who live in the “measurement” world, there is A LOT to consider. Clearly, measures have under-delivered.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0226t
For those of us who live in the “measurement” world, there is A LOT to consider. Clearly, measures have under-delivered.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0226t
Decades of trying to change physician compensation based on quality, performance, and value have not led to meaningful improvements.
Could professionalism be the spark?
Could professionalism be the spark?
At the onset of the COVID pandemic, physicians and nurses “did not retreat from compassion.”
“No financial incentives or performance measures were required to prompt their efforts; in fact, many pitched in against their financial self-interest.”
“No financial incentives or performance measures were required to prompt their efforts; in fact, many pitched in against their financial self-interest.”
This was professionalism at its best: "patient welfare...served by physicians’ knowledge and concern."
However, for a variety of reasons, physician professionalism has been eroded.
However, for a variety of reasons, physician professionalism has been eroded.
Measures may have distracted from “harder-to-measure, but equally or more important aspects of care…”
“Performance measures detect the symptoms of dysfunction, not necessarily the cause” and lead to “…teaching to the test or gaming.”
“Performance measures detect the symptoms of dysfunction, not necessarily the cause” and lead to “…teaching to the test or gaming.”
Worse, measure focus leads to demoralization.
“Purpose is undermined as demands on physicians diverge from their values, professional identity is lost, and intrinsic motivation gives way to a self-fulfilling prophecy that physicians care only about financial incentives.”
“Purpose is undermined as demands on physicians diverge from their values, professional identity is lost, and intrinsic motivation gives way to a self-fulfilling prophecy that physicians care only about financial incentives.”
Just a few recommendations from @JMichaelMcW, to tap professionalism:
-Reduce the isolation of medical practice
-More focus on the physician hive mind to assess quality, crowdsourcing answers
-Make it easier to teach and learn from others
-Reduce the isolation of medical practice
-More focus on the physician hive mind to assess quality, crowdsourcing answers
-Make it easier to teach and learn from others
One question for @jmichaelmcw:
Don’t I need measures to know if I am doing right by my patients?
(the distinction between “measures” and “information” seems artificial)
Don’t I need measures to know if I am doing right by my patients?
(the distinction between “measures” and “information” seems artificial)
Again, a terrific, thought-provoking piece by @JMichaelMcW in @nejmcatalyst.
If you work with "quality measures," you have to read this.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0226t
If you work with "quality measures," you have to read this.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0226t
