Several years ago, we bought a house with a truly fabulous kitchen-high-end everything, including a German-engineered faucet that brought us to our knees trying to figure out how to turn it on. (I kid you not: this was a literal description, as we tried everything including getting on our knees and searching under the sink for a clue to the mystery.)
Finally, we surrendered and called the previous owners to inquire, “How the hell do you to turn this blasted thing on?” Upon learning the faucet’s secret (the handle had to be pushed out perpendicular to, not front-to-back parallel with, the part where the water came out) we had that “light dawns over Marble Head” moment — when you say, “Duh! Why didn’t I think of that?”
Here’s why. We had a vision — a memory, an understanding — in our heads (even in our muscles!) of how all the handles we had ever used operated, and although the explanation of how this new faucet turned on was unbelievably simple, it was in no way self-evident. We were completely incapable of imagining that this unfamiliar faucet could be controlled in any way other than the ones with which we were already quite familiar.
I have found the same observation can be made about the ways we might consider for displaying inverted performance measure results; that is, results for a metric where a lower score is better, but within a larger group where a higher score is the most common goal. Like our mystifying faucet handle, these measure results show progress, or positiveness, or success in a different way from what we are accustomed to expect — and the clearest and most effective way to display both the results and the difference is both simple and most assuredly not self-evident.
Consider the following list of select clinical process effectiveness measures. For all but one of them (“Diabetes Mellitus Hemoglobin A1c Poor Control in Diabetes Mellitus”) — the desired goal is a higher rate. With the measure named here (the second item on the list in the illustration below), a lower score is better. How can we make this instantly clear in a bar-graph display?
Simple, fast solution: orient the relevant bar graph in the opposing direction.
For the measures we want to score high, it is logical to show results as the length of a bar that begins at 0% and ends at the actual score. Further, presenting the bar this way shows the direction of our progress as we work toward the highest possible score of 100%. Turning the scale in the mind’s eye to display a lower score when that is the goal leads to the desired interpretation by displaying progress as movement toward the best result, or 0%.
Take a minute to look at this design change in the graphic above. The highest possible score is 100%, but in the highlighted case, that’s the worst result: the desired goal is closer to 0%. By orienting the bar with the result displayed to the left of 100%, we signal that movement away from it and toward 0% is in the desired direction.
Through use of this simple technique, performance measures can be stacked one right after the other in a single column, making it all of the results very easy to see, and the improvement opportunities to identify.
I must tell you — although we joke about that fancy faucet, which was a bit too clever for my taste — I still remember the experience, the sting of being baffled by an inanimate object, and the lesson all this taught me. If I can’t figure out how something works, I don’t keep trying the failed method in the hopes that the situation will change. (“Repeating an unsuccessful action in the hope of different results is the definition of insanity.”) Instead, I try to step back, consider the bigger picture, and work on another way to solve the problem. If all else fails, I do what we did that long-ago day in our new kitchen: I ASK someone with more brains — or at least more familiarity with the problem — than I!