Gap Year metrics: how to fit it all in

DEM_RAM_Aug2013Andy*, this one is for you, but you have to read to the end to get the rant.

It has been about two weeks since I returned to Maine from visiting my father in Milwaukee. This is peak summer vacation time and, indeed, that is what I have used it for.

A Gap Year principle that I am passing along is: do not over schedule; you will fail. That’s especially important when your body clock says “Maine! Vacation!”

As I have said before, if I could practice medicine, run the business of a private practice, serve on non-compensating boards and committees, maintain a family life as well as a Washington social life AND… write a book, reform health care and plan exotic trips, then I would not need a Gap Year.

But I cannot do all those things and so I need a break in August.

Reminder: why a Gap Year

Now that I have the time to enjoy an extended family visit in my favorite place on the planet, I still do not have the mental energy or strength to pay my day-to-day bills, play golf, sail, repair motor boats, babysit for two toddlers, prepare fresh seafood for island guests and in-laws AND research health care reform, research French lessons, research exotic travel (safe, yet outside the “tourist bubble”) and think about job opportunities for next year.

Something has got to go.

I have to remind myself that when I first began this year I knew that June would be a month of transition, July would be a combination of events and projects (finish the guest house, go to the World Domination Summit, visit my father) and August would be spent trying to have an extended summer vacation without the time pressure of past visits.

Measuring the perfect eight-hour day

The lesson I have learned is that while I had hoped to plan and research my Gap Year projects simultaneously, that is not going to happen.

My dream of a structured eight-hour day of research reading, personal growth reading, exercise, writing (touchy-feely blog posts, health care rants, personal notes), French exercises, etc. has not worked. I am unsettled over the fact that I cannot do it all and cannot decide what to do first.

Therefore, I am letting my grand plans wait a few more days until my grandbaby toddlers decamp and I can dial down in-law visits. Then, I promise I will get my schedule set and Debbie and I will start and end each day with briefings, progress reports and a review of Gap Year “metrics.” [Ed note: looking forward to this. – Debbie]

And now… a rant about healthcare metrics

Ok, let me rant about metrics for a minute. Does your business have metrics? Is it ruled by metrics? Do they work?

I suppose metrics have a role in terms of dollars and cents, time sensitive production issues and quality control of widgets. They may even have some role in the management of hospital systems and medical care.

I will grant that keeping the “post sternotomy blood sugar below 200 mg/dl” is associated with better outcomes and fewer wound infections (I’ll bet most of you don’t know what that means and never thought it would be measured) and is a laudable goal.

But is it a metric we should pursue? Everything can be turned into a metric. Should we do so?

Our rankings have slipped; what metric shall we improve?

I remember well a quality committee meeting at a WFMC (World Famous Medical Center, to the uninitiated) where the business people outnumbered the health care providers.

Three issues come up over the course of an hour. These were how many patients were dying of septic shock per month; how many patients dying of septic shock should be or were palliative care patients; and how much time elapsed between the first symptoms of septic shock, its diagnosis and the initiation of treatment.

Because of the high mortality of septic shock patients at this WFMC, its standings in the U.S. News and World Report rankings had slipped and the bean counters wanted to improve these metrics.

Conflating improved patient care with improved metrics

Suddenly these issues were conflated into a single management tool. It was proposed that a Septic Shock Rapid Response team could be created and the time from notification to treatment could be monitored.

Recognizing that much of the delay in treatment (and therefore the success of treatment) could be attributed to family discussions about appropriate care in a palliative care situation, it was proposed that diagnosis and treatment be instituted before a definitive family decision.

Well, if you have not seen the initiation of a septic shock work up you do not want to see one now. And, if you have you would not wish it on a family member in or near a palliative care status. It is brutal.

Fortunately, reason prevailed, at least briefly, and the metric managers looked elsewhere for something to monitor.

Patients are not widgets

People are not widgets. ER throughput of patients (another metric) should not be about filling beds to make more money but should be about getting the patient to the appropriate care level in the appropriate time period (a judgment, not a metric).

I am going to play golf, but I am so angry thinking about metrics that I am not going to keep score.

[Ed note: thanks to cousin Andy for being a loyal reader of this blog. As for golf, Sam reported back that he was six over par after six holes. Then he quit. – Debbie]

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