My career in healthcare started when I was hired straight out of college as the finance manager of a community hospital. My co-workers called me “Sprout,” as in “she’s as young and green as a new sprout.” They were SO very funny and clever! I was, it’s true, young and inexperienced; I was also tenacious.
Fueled by youth and ambition–and the desire to shed that nickname–I earned my co-workers’ respect as we all try to, by working hard and proving myself. Once I caught a bank error in the amount of interest that we should have been credited on an investment. I was tireless and meticulous in reviewing third-party-payer remittance advices (a black hole of endlessly ill-defined information), and diligent in holding those payers accountable for incorrect amounts.
I also paid careful attention to the hospital’s monthly financial reports–making certain that they reconciled, and that I understood every last number in the summary and supporting detail sections. I studied each figure like a dog with a bone until I understood it well enough to explain it to someone else; and if I couldn’t do that, I asked questions until I could. If the answers didn’t make sense to me, I hung on until they did, or the error I’d suspected was corrected. Soon, the adjective “annoying” was added to my nickname.
We might expect that part of a job in finance is to do these things, right? Calculations should reconcile. We should make sure that we’re being paid correctly. We should be able to interpret and explain reports. Of course we should.
The exact same things are true about performance-improvement and quality and safety reporting. The numbers have to reconcile. We must know that our data are being reported correctly. We should be able to explain reports.
Unfortunately, many numbers don’t; our data aren’t; we can’t.
A couple of weeks ago, I conducted a private workshop for a group participating in a national quality-improvement program. The workshop taught how to use program reports to identify quality-improvement opportunities and to gain buy-in for those efforts. The gargantuan, glaring problem, however? Not only did the national program reports not reconcile, but many of the individual calculations were simply and obviously wrong.
- The total number of patients in the summary report didn’t equal the number of patients in the supporting detail report.
- Where rates should have added up to 100%, they didn’t. Sometimes they were larger (a population with a 105% rate of diabetes? Does the Surgeon General know about this?), sometimes smaller.
These errors were just the tip of the proverbial iceberg. The more the group dug into the reports, the more problems they found. “How can we possibly present this data and have any credibility at all?,” its members cried in panic. Of course, they couldn’t possibly.
How can we avoid getting into such a mess?
First, gather the evidence; do, as they say, the math:
- Get out your calculator and make sure that the data add up correctly.
- Calculate for yourself the rates shown on the reports. Do you get the same answers? Do they make sense to you? Can you explain them? Are the correct denominators being used? Do you know what denominators and numerators are?
- Cross-reference data from summary and from detail reports. They should agree, and you should be able to follow the flow from summary data to supporting details and back again.
- If the report contains complex calculations, do you have access to the calculation methodology? Can you explain it to another person? Do the calculations seem reasonable? Understandable?
- Recruit a colleague to take a look. Sometimes a fresh pair of eyes sees things that we can’t.
Next, make the case:
- Document your findings in as much detail as possible and report the problems to the group creating the reports.
- Don’t leave any ambiguity about the problems you have found or the questions you are asking.
Finding yourself at a dead end?
- Build strength with numbers: engage other people using the reports, and add a choir to your voice.
Whatever you do, don’t give up, because if you present incorrect data using reports that are incorrect, you will lose your credibility. And as bad as that outcome is (very), it will lead to something far worse: your decisions will be ill-informed, and they may even be dangerous, unethical, illegal, or litigable. You wouldn’t put up with that quality of work from your bank. Why accept it from someone whom you are paying to do reports for you? You shouldn’t; you mustn’t.
And last but not least, hold the vendors accountable and stop paying for lousy reports (that usually gets someone’s attention). If they start calling you “Annoying Sprout,” you’ll know you’re making headway.