This Visit May Be Recorded

By ALAN SCHWARTZ and SAUL WEINER In their 1993 book, Reinventing Government, David Osborne and Ted Gaebler entitled a section “what gets measured gets done.” Unfortunately, when it comes to improving health care quality, safety, and costs, we often fail to observe the real work of care, and miss the chance to get it done better. To make a real difference, we need to begin measuring care when and where it happens – behind the curtain. Why We Must Directly Observe Patient Care For the last 10 years, our work in research and quality improvement has used concealed audiorecorders to capture what actually happens during patient-physician encounters, and to provide feedback to physicians about their performance. Much of our focus has been on demonstrating the importance of appreciating the patient’s life context and showing how encounters in which physicians elicit patient context and incorporate it into care planning have better health care outcomes and lower costs from inappropriate care. We’ve found such contextual factors are relevant to health care in two-thirds of encounters, that physicians ask about them less than a third of the time, and when they are discovered, they are incorporated into the plan less than 60% of the time. Contextual errors—inappropriate care due to failure to contextualize—are pervasive. Records Don’t Record Only direct observation of care reveals these errors. The medical record, currently the source of most data in performance improveme...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs