I practiced surgery for many years in a very large hospital. In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.” About the same time, two of my colleagues created the Hernia Institute, sensing gold in them them groins. They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs.
These initiatives had two things in common:
- they attempted to appeal to patients and referring physicians through an implicit message of high quality care
- their messages, though perhaps rationally defensible, were entirely without supporting data
The absence of data was symmetrical: the competition had none with which to refute or counter the messages. That’s because no one had any quality data at all. Healthcare had made no substantive attempt at measuring quality, except in research trials and the like. Clinical practice was virtually unexamined, so anyone could make any claim without fear of rebuttal.
It is to our discredit as physicians that we muddled along, practicing what we knew to be best, attending the occasional meeting, perhaps reading some professional literature, but never looking in a rigorous way at what we were achieving and what we were missing. We deflected calls for us to do so by asserting that medicine was too complex to be measured.
A fundamental mantra of business students is, “If you cannot measure it, you cannot manage it.” As healthcare costs spiraled and apparent benefits did not keep pace, there was increasing pressure — and rightly so — to manage the resources being consumed, in a way that ensured quality improvement.
That meant quality had to be measured, but we as a profession sat with our hands folded and essentially engaged in a staring contest.
