Advertise on Bikeforums.net



User Tag List

Page 2 of 2 FirstFirst 12
Results 26 to 43 of 43
  1. #26
    Around now and then DnvrFox's Avatar
    Join Date
    Aug 2001
    Location
    Around now and then
    Posts
    20,876
    Mentioned
    1 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by Dudelsack View Post
    Very well said. Extremely well said.

    One thing that's easily confused: although closely related, quality care and safe care are not synonymous. As I think about the OP, what is being published is safety ratings, which are pretty straightforward, rather than quality assessment, which is much more difficult to quantify.
    FWIW, there have been a couple of changes in our MD, ER and hospital experiences.

    One is an emphasis on fall prevention.

    Every time we see a doc, etc., we are asked if we have fallen; or, if not, do we have a fear of falling. If so, our charts are coded appropriately. Personally, I think this is good.

    Also, staff are generally more positive and friendly. Sometimes a lot and a marked change from in the past. I believe this is caused by the new?? patient ratings in the Medicare pro forma.

    As Dudel pointed out, these are safety ratings, not quality ratings. I am not pro or against. I just think we need to know what is happening in the world of medicine that affects us as 50+'rs.
    DnvrFox - still bicycling, swimming, walking and weight lifting at 74yo is participating a bit in BFN 50+.

  2. #27
    Travelling hopefully chasm54's Avatar
    Join Date
    May 2010
    Location
    Uncertain
    Posts
    6,696
    Mentioned
    4 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by MikeWMass View Post
    In my area they gave A's to one place that I wouldn't send YOUR dog, and a couple of places that (appropriately) transfer their complicated patients as quickly as they can. They gave a C to one of the two major hospitals in the area and an A to another, and many of the physicians and surgeons there are on staff of both of those. I agree that safety and quality are difficult to quantify. However, as we move forward, putting systems in place so that your safety is not solely dependent on which doctor has admitted you requires redesigning how care takes place. Team building exercises are not irrelevant, because they indicate the culture at the institution (assuming that they are really taken to heart and not just done in a pro forma manner). Having said that, I agree that these ratings do not provide a reliable guide to where to go, but they may give some indication of which institutions are keeping up with current thinking in medical safety and, to a lesser extent, quality of care.
    I don't disagree. However, I've done a lot of this and I would predict with considerable confidence that if holding team building exercises becomes a measurement against which a hospital is judged, then those exercises will be held in a formulaic manner in order to satisfy the measurement, rather than developed to meet the specific needs of the teams concerned.

    Amd that is always the problem with proxy measures. Once they are adopted for the purpose of assessment or enforcement they lose their usefulness, because people change their behaviour in response to what is being measured. Goodhart's law What gets measured tends to be what gets done. Which is why it is really important to make sure one is measuring the right things.
    There have been many days when I haven't felt like riding, but there has never been a day when I was sorry I rode.

  3. #28
    Senior Member
    Join Date
    May 2008
    Posts
    2,375
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    The tone of a couple posts is rather dismissive of the ratings. Perhaps that tone was unintended in the desire to point out that there is more to having a quality experience in hospital than safety? That indeed is true. But just because it is difficult to fully analyze all aspects of a hospital operation doesn't mean less than full analysis are useless. Quite the contrary.

    Evaluations when done with motives to communicate with all parties, including customers, and to improve performance are evolutionary in nature. As things are disclosed and remedial efforts are made methodology is improved. As methodology improves other metrics are found to be useful and measurements are developed. On the other hand; if the motive is to keep customers/patients in the dark as much as possible will complying with the law proper analysis will remain in a quagmire.

    Perhaps taking some lessons from the aviation industry would be appropriate. Everyone got with the program and developed a comprehensive set of performance metrics and analysis methods. The result was transforming the industry from one that was hazardous, much as entering a hospital today, to one that is arguably the safest transportation method.
    It is better to smell the flowers than taste the roots.

  4. #29
    Hey guyz? Guyz? Wait up!! Siu Blue Wind's Avatar
    Join Date
    Apr 2005
    Posts
    10,475
    Mentioned
    1 Post(s)
    Tagged
    0 Thread(s)
    Off topic here:

    I've cleaned up a few posts here that were stirring the pot and I am expecting no more of the same. Thank you.
    Quote Originally Posted by Buddha
    We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world.
    Quote Originally Posted by making View Post
    Please dont outsmart the censor. That is a very expensive censor and every time one of you guys outsmart it it makes someone at the home office feel bad. We dont wanna do that. So dont cleverly disguise bad words.

  5. #30
    Travelling hopefully chasm54's Avatar
    Join Date
    May 2010
    Location
    Uncertain
    Posts
    6,696
    Mentioned
    4 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by HawkOwl View Post
    The tone of a couple posts is rather dismissive of the ratings. Perhaps that tone was unintended in the desire to point out that there is more to having a quality experience in hospital than safety? That indeed is true. But just because it is difficult to fully analyze all aspects of a hospital operation doesn't mean less than full analysis are useless. Quite the contrary.

    .
    No, in my case the dismissive tone was entirely intentional. Less than full analysis can be useful, certainly. But grossly superficial analysis is not better than nothing, it is worse than nothing, because it has the potential to mislead and to distort behaviour.

    If hospitals are required to respond to poorly-set objectives, they will do so. And that will cause them to behave in ways that actually militate against an improved standard of care. I've seen it many times, including - I regret to say - in hospitals for which I was responsible. People start to try to meet the target, even when they know that doing so diverts effort from the real objective. That can have dangerous consequences.
    There have been many days when I haven't felt like riding, but there has never been a day when I was sorry I rode.

  6. #31
    Senior Member
    Join Date
    May 2008
    Posts
    2,375
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    No, in my case the dismissive tone was entirely intentional. Less than full analysis can be useful, certainly. But grossly superficial analysis is not better than nothing, it is worse than nothing, because it has the potential to mislead and to distort behaviour.

    If hospitals are required to respond to poorly-set objectives, they will do so. And that will cause them to behave in ways that actually militate against an improved standard of care. I've seen it many times, including - I regret to say - in hospitals for which I was responsible. People start to try to meet the target, even when they know that doing so diverts effort from the real objective. That can have dangerous consequences.
    Absolutely true that responding to poor objectives results in poor result. That was true early on in the aviation industry. But, rather than dismissing the methods the focus was on how to improve them. To just dismiss something as not being as good as it can be without offering an alternative is to place a stumbling block in the road of progress.

    People do positively respond to clear goals and procedure clearly communicated and enforced. That is a major tool that can be used to improve the safety of the medical industry.

    I don't argue for even a moment that the cited study is the end all of hospital evaluation. But, right now it, or its' rough equivalent, is about all we have outside of the inside industry certifications. The person or organization that designs a workable evaluation system that presents useful information to the customers and allows the industry to focus on positive outcomes will not only perform a great service, but will probably make a mint.
    Last edited by HawkOwl; 05-18-13 at 07:19 PM.
    It is better to smell the flowers than taste the roots.

  7. #32
    A might bewildered... Dudelsack's Avatar
    Join Date
    Oct 2011
    Location
    Loovul
    My Bikes
    Bacchetta Giro ATT 26; Lemond Buenos Aires
    Posts
    6,268
    Mentioned
    15 Post(s)
    Tagged
    1 Thread(s)
    Quote Originally Posted by DnvrFox View Post

    Also, staff are generally more positive and friendly. Sometimes a lot and a marked change from in the past. I believe this is caused by the new?? patient ratings in the Medicare pro forma.
    This is a real phenomenon, although I'm not sure what's behind it. I don't think it's government incentives. I personally suspect the Internet and the "democratization of healthcare" are major contributors. It's the old saw: make one person happy and he'll tell a few of his friends. Get someone ticked off at you and they post it on Facebook and heaven help you.

  8. #33
    Older I get, faster I was con's Avatar
    Join Date
    Dec 2008
    Location
    santa cruz
    Posts
    654
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    It's not exactly rocket science to work out that the Stanford University Medical Centre, one of the best-resourced and most eminent hospitals in the world, is likely to be superior to your local hospital when dealing with complex medical problems. That has absolutely no bearing on whether these ratings are meaningful. If you use them to inform your decisions in where to seek treatment, you're going to make a lot of poor judgements..
    You "sound" really angry. Ya know this is just a bicycle forum.

    BTW, thank you for your concern; however, I have done just fine with the many complex medical decisions I have been called upon to make in my life.

  9. #34
    Travelling hopefully chasm54's Avatar
    Join Date
    May 2010
    Location
    Uncertain
    Posts
    6,696
    Mentioned
    4 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by HawkOwl View Post
    Absolutely true that responding to poor objectives results in poor result. That was true early on in the aviation industry. But, rather than dismissing the methods the focus was on how to improve them. To just dismiss something as not being as good as it can be without offering an alternative is to place a stumbling block in the road of progress.

    People do positively respond to clear goals and procedure clearly communicated and enforced. That is a major tool that can be used to improve the safety of the medical industry.

    I don't argue for even a moment that the cited study is the end all of hospital evaluation. But, right now it, or its' rough equivalent, is about all we have outside of the inside industry certifications. The person or organization that designs a workable evaluation system that presents useful information to the customers and allows the industry to focus on positive outcomes will not only perform a great service, but will probably make a mint.
    I certainly agree with your last point. And I'm not aiming to be a stumbling block to progress. The number of constructive suggestions I have for addressing the problem of measuring hospital performance would fill a box file (are there still such things as box files?) and would certainly come into the tl;dr category on an internet forum.

    And of course people respond to clear goals and procedure clearly communicated and enforced. Trust me, though, this is extremely difficult to achieve in the healthcare arena and very susceptible to manipulation, because of the difficulty of measurement. And the financial incentives to game the system are huge. A hospital's apparent performance can be transformed by diagnostic drift - that is, by assessing a patient's condotion as x or as x with complications. What constitutes a complication is not amenable to objective measurement in real-time, it is the judgment of medical and other professionals. And the judgment of medical professionals is not immune to financial, managerial, authoritarian, peer pressures. Healthcare is not engineering.

    My objection to assessment systems of the sort highlighted in this thread is that they are not "the best we can do". They are "the easiest we can do". They consist of a lazy and inexpensive attempt to derive judgments from data that are both partial and inaccurate. We could do much better, even given the current state of available information, were we prepared to spend some time and money without expecting quick or simple answers.
    There have been many days when I haven't felt like riding, but there has never been a day when I was sorry I rode.

  10. #35
    Travelling hopefully chasm54's Avatar
    Join Date
    May 2010
    Location
    Uncertain
    Posts
    6,696
    Mentioned
    4 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by con View Post
    You "sound" really angry. Ya know this is just a bicycle forum.

    BTW, thank you for your concern; however, I have done just fine with the many complex medical decisions I have been called upon to make in my life.
    Why would I be angry? I really have no stake in where you seek treatment, or in your opinions about this evaluation system. I'm merely pointing out that what you posted about the AARP assessments didn't make much sense.
    There have been many days when I haven't felt like riding, but there has never been a day when I was sorry I rode.

  11. #36
    Senior Member
    Join Date
    May 2008
    Posts
    2,375
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    I certainly agree with your last point. And I'm not aiming to be a stumbling block to progress. The number of constructive suggestions I have for addressing the problem of measuring hospital performance would fill a box file (are there still such things as box files?) and would certainly come into the tl;dr category on an internet forum.

    And of course people respond to clear goals and procedure clearly communicated and enforced. Trust me, though, this is extremely difficult to achieve in the healthcare arena and very susceptible to manipulation, because of the difficulty of measurement. And the financial incentives to game the system are huge. A hospital's apparent performance can be transformed by diagnostic drift - that is, by assessing a patient's condotion as x or as x with complications. What constitutes a complication is not amenable to objective measurement in real-time, it is the judgment of medical and other professionals. And the judgment of medical professionals is not immune to financial, managerial, authoritarian, peer pressures. Healthcare is not engineering.

    My objection to assessment systems of the sort highlighted in this thread is that they are not "the best we can do". They are "the easiest we can do". They consist of a lazy and inexpensive attempt to derive judgments from data that are both partial and inaccurate. We could do much better, even given the current state of available information, were we prepared to spend some time and money without expecting quick or simple answers.

    The points you recite are not peculiar the medical industry. They pertain to several industries. To put a sharper point on it the main problem is not the details you recite; but the lack of desire, indeed almost active opposition, to work on having meaningful metrics.

    Yes, any system can be manipulated to bias reports in this way or that. But, if people truly want to have meaningful measures that bias has a tendency for the most part to work its' way out of the system. You say certain factors are not amenable to measurement. I submit that such is not the case. Quality of judgment is very much a measurable factor. The US military does it routinely and successfully. Much of the employment of military forces is a matter of judgment by the person in charge. Many, if not most, of the factors involved are fluid and subjective. But, measure they do and because they have decided on what a good outcome is. Other industries have done the same. The medical industry is hiding behind factors that can and have been handled in other no less important and complex settings.

    No, the arguments you cite have been raised and dealt with in many other places. That they are still able to be raised in the medical industry is testimony to its' political power and ability to escape modern management. Given that, the cited information is about as good as can be obtained by the customer. As such the customer who uses this information is doing the best job possible when they make their decisions.

    (Well, actually, what I say is only partially true. Most everyone I have met in the industry recognizes that the real customer is the person paying the bills, the insurance company, not the person/patient who brings the income producing situation to the hospital).

    On a macro level some very good data currently exists. It just isn't generally available to the general public nor to the medical technical folks. Insurance companies base their rates generally on income, risk, and general political goals. To do that they have some very good data and analysis thereof. Also, exactly how to manipulate the billing and political systems has been honed to a fine art by hospitals and others. To do that they have had to develop good data collection and analysis systems.
    Last edited by HawkOwl; 05-19-13 at 03:35 PM. Reason: Add macro related comments.
    It is better to smell the flowers than taste the roots.

  12. #37
    A might bewildered... Dudelsack's Avatar
    Join Date
    Oct 2011
    Location
    Loovul
    My Bikes
    Bacchetta Giro ATT 26; Lemond Buenos Aires
    Posts
    6,268
    Mentioned
    15 Post(s)
    Tagged
    1 Thread(s)
    Quote Originally Posted by chasm54 View Post

    My objection to assessment systems of the sort highlighted in this thread is that they are not "the best we can do". They are "the easiest we can do". They consist of a lazy and inexpensive attempt to derive judgments from data that are both partial and inaccurate. We could do much better, even given the current state of available information, were we prepared to spend some time and money without expecting quick or simple answers.
    As someone who 1. has given this a lot of thought, 2. has the proverbial skin in the game, and 3. seen what happens when QA is done wrong by clipboard jockeys, I can tell you that this is absolutely true.

    Well done, Chasm (I think the earth just shifted on its axis).

  13. #38
    Older I get, faster I was con's Avatar
    Join Date
    Dec 2008
    Location
    santa cruz
    Posts
    654
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    Why would I be angry? I really have no stake in where you seek treatment, or in your opinions about this evaluation system. I'm merely pointing out that what you posted about the AARP assessments didn't make much sense.

    Yur kill'n me here. I guess I just found your comments a few posts back directed at me, not the topic, to be rather abrasive. Oh well, it is just a bicycle forum. I'm done at time with this topic.

  14. #39
    Older I get, faster I was con's Avatar
    Join Date
    Dec 2008
    Location
    santa cruz
    Posts
    654
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    Why would I be angry? I really have no stake in where you seek treatment, or in your opinions about this evaluation system. I'm merely pointing out that what you posted about the AARP assessments didn't make much sense.

    Yur kill'n me here. I guess I just found your comments a few posts back directed at me, not the topic, to be rather abrasive. Oh well, it is just a bicycle forum. I'm done at this time with this topic. Mmmmm, posted two times, guess I'm really done!
    Last edited by con; 05-19-13 at 03:47 PM.

  15. #40
    Travelling hopefully chasm54's Avatar
    Join Date
    May 2010
    Location
    Uncertain
    Posts
    6,696
    Mentioned
    4 Post(s)
    Tagged
    0 Thread(s)
    Dudelsack, everything is contextual. Even a stopped clock is right twice a day, and even the most irascible old git can occasionally know what he's talking about.

    HawkOwl, I really think we may be at cross-purposes. I'm not suggesting that we couldn't measure the performance of healthcare providers. It is difficult but not impossible. I'm suggesting that the system of incentives and rewards that we currently employ are counterproductive. I am absolutely in favour of transparency and making information available. But the way data is, typically, presented and interpreted is not transparent, but obfuscatory. And the analyses that do make it into the public domain, are, mostly, crap.
    There have been many days when I haven't felt like riding, but there has never been a day when I was sorry I rode.

  16. #41
    Senior Member
    Join Date
    May 2008
    Posts
    2,375
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by chasm54 View Post
    Dudelsack, everything is contextual. Even a stopped clock is right twice a day, and even the most irascible old git can occasionally know what he's talking about.

    HawkOwl, I really think we may be at cross-purposes. I'm not suggesting that we couldn't measure the performance of healthcare providers. It is difficult but not impossible. I'm suggesting that the system of incentives and rewards that we currently employ are counterproductive. I am absolutely in favour of transparency and making information available. But the way data is, typically, presented and interpreted is not transparent, but obfuscatory. And the analyses that do make it into the public domain, are, mostly, crap.
    Houston, We Have Lift Off! Absolutely agree with what you finished with. Today's medical industry is more about power, politics and profit than anything else. It takes some study to realize that, in reality, except for some individual providers, the patient is merely the bearer of something that will lead to income.

    Also, that the safety measure that the OP started with is merely a slice, a small slice, of the pie. But, it is part of the pie and a small slice is better than none at all; as long as people realize its' relationship.
    It is better to smell the flowers than taste the roots.

  17. #42
    Senior Member
    Join Date
    Jun 2004
    Location
    Northern Nevada
    Posts
    3,744
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)
    Quote Originally Posted by rydabent View Post
    A small percentage of people myself included fortunately have nothing to do with hospitals. I will be 75 this year, and have never been in a hospital or had any kind of operation. I have everything I was born with plus 32 teeth. Doctors love to take out things like gall bladders etc, but I managed to stay away from them. Hospitals, even good hospitals have alway been known to give many people all sorts of dieases.
    This is nice for you, but really meaningless. I took good care of myself and spent only one night in a hospital in 66 years, getting my tonsils out when I was 8. In 2011 I developed myasthenia gravis and spent five weeks in ICU and two months in inpatient rehab. It's completely unpredictable, not lifestyle related, no family history, and it cost $660,000. Don't let your insurance lapse.

  18. #43
    Around now and then DnvrFox's Avatar
    Join Date
    Aug 2001
    Location
    Around now and then
    Posts
    20,876
    Mentioned
    1 Post(s)
    Tagged
    0 Thread(s)
    Mods - could we close this thread, please?

    Tx
    DnvrFox - still bicycling, swimming, walking and weight lifting at 74yo is participating a bit in BFN 50+.

Page 2 of 2 FirstFirst 12

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •