Have a “Good One” What?

So, here is what is bugging me today…inexact speech and ambiguous directives.

Precisely what do people mean when they tell me to “have a good one?” Do they mean that I should have a good…

  • Life?
  • Day?
  • Colonoscopy?
  • Long walk off a short pier?

I am begging someone to tell me what “good one” everyone wants me to have.

“Have a good one” has become so ubiquitous and meaningless that I turn a completely deaf ear to it. I ignore the sentiment (whatever it is exactly) and the person saying it to me.

This of course is just the proverbial tip of the iceberg.

Vague and ambiguous performance measures, reports and goals by healthcare organizations have the same “crazy making” effect on me…and contrary to urban legend it actually does take quite a bit to make me crazy so you know it’s bad out there.

Take a moment to consider and answer the following five summary questions designed to assess how precise or imprecise your organization is in their statement of goals and objectives, and the use of data to achieve and measure results.

1. Which statement best descries how measurable your strategy is?

Imprecise: We have countless goals and objectives because everything matters.

Precise: We have mindfully reduced our goals and objectives to a realistic and manageable number and we have used clear language to describe them. Our goals and objectives are statements about the impact we want to make, the results or difference we want to achieve.

For example, “we will achieve a 95% positive response rate on all HCAHPS patient communication measures by December, 2012.”

2. How meaningful are your measures?

Imprecise: We use milestones or actions as measures, e.g., “implement new catheter management policy” or “improve patient satisfaction.” And we use words like “productivity” or “adverse outcome” with no clear description of exactly what the measure is.

Precise: Every measure is objective evidence that regularly gauges the degree to which a performance result is occurring over time.

For example, “hospital acquired urinary tract infection (UTI) rates confirmed by lab results will be reported monthly. The rate will be calculated per 1,000 patient days.” The measure has a clear and unique name accompanied by a description about exactly what is being measured.

3. How well are your performance measures documented, understood and implemented?

Imprecise: There is no guarantee that measures are measuring what they ought to — there is duplication, different versions of the truth, incorrect calculations and analysis used. Most measures are reported without clear intention and definitions and there is no central catalogue of the data definitions for end users to reference.

Precise: Every measure’s calculation formula is clearly detailed and consistently applied. There is one version of the truth for each measure. Every measure’s purpose is clear and well documented and its owner knows the appropriate responses to take depending on the measures warnings and indications.

We have a well-developed and maintained data definition catalogue that is easily accessible to all stakeholders. New measures may not be added without this accompanying information.

4. How useful and usable are your performance reports and dashboards?

Imprecise: Performance reports are ad-hoc or non-existent. There is no standard performance reporting process we follow. We use pie charts and default dashboard tools such as dials and gauges — whatever we think “looks” good and won’t “bore” our viewers.

Precise: Each performance report or dashboard is designed for a specific audience, tailored to the measures and results they need and produced regularly, routinely and reliably.

The staff is trained in and applies the best practices of table, graph and dashboard design in the development and publication of reports. The message in our reports may be understood “at-a-glance.”

5. How well are performance measures and strategies improving performance?

Imprecise: We assess performance by comparing this month to last — or this week to last week — or this month this year to the same month last year. And, we often rush to implement initiatives without testing a proof of concept and building stakeholder buy-in through clear communication

Precise: We use statistically valid methods and root cause analysis to determine when performance has changed, so we don’t react to differences that are part of normal variation. Our data is readily available and easily understood, so that any system that could cause harm or some other adverse event, is identified and corrected before targets are missed or patient care suffers.

Here is the bottom line — ambiguous speech results in ambiguous action and ambiguous results — and around we go. And worse than the frustration we create, we miss opportunities to truly connect with one another and to accomplish important work.

Well, you know what is coming…here is a “good one” (quote that is from the philosopher Thomas Reid) that sums it up for me:

“There is no greater impediment to the advancement of knowledge than the ambiguity of words.”

Now that is precise.

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