Dr. Robert Wachter: The problem with measurement and benchmarks in healthcare

Although benchmarking in healthcare started with good intentions, the measurement of all processes has become more of a burden than a tool to improve processes and outcomes. Too much emphasis is placed on numbers, argues Robert Wachter, MD, professor and interim chairman at the department of medicine at University of California, San Francisco, in a New York Times opinion piece. "We're hitting the targets, but missing the point," he wrote.

One key indicator of the overuse of measurement and benchmarks is the proliferation of lists and rankings, Dr. Wachter wrote. This measurement "fad" has produced so many lists that more than 1,600 hospitals can say they are on a "Top 100" or "Best Hospital" list. 

Additionally, burnout is a measurement indicating the overuse of technology, according to Dr. Wachter, as EHRs are noted to contribute to employee burnout. "The computer systems have become the dark force behind quality measures," he wrote.

As the pressure to perform well to meet benchmarks mounts, other elements of care seem to be pushed to the wayside. If benchmarking is going to persist in healthcare, Dr. Wachter suggests the industry select more direct and effective benchmarks.

"Measurement cannot go away, but it needs to be scaled back and allowed to mature. We need more targeted measures, ones that have been vetted to ensure that they really matter," Dr. Wachter wrote. "For example, measuring the rates of certain hospital-acquired infections has led to a greater emphasis on prevention and has most likely saved lives. On the other hand, measuring whether doctors documented that they provided discharge instructions to heart failure or asthma patients at the end of their hospital stay sounds good, but turns out to be an exercise in futile box-checking, and should be jettisoned."

At the core of the issue, Dr. Wachter wrote the industry needs to listen to clinicians if and when they have complaints and concerns about benchmarking practices. "We have to ask our clinicians…whether measurement is working, and truly listen when they tell us that it isn't. Today, that is precisely what they're saying," he wrote.

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