## I Know You Are But What Am I?

Did you know that Pee-wee Herman has a new Broadway show? It’s true — from the Playhouse to Broadway, Pee-wee is back on top and packing them in.

Just the name Pee-wee Herman caused his famous one liner, “I know you are but what am I?” to come screaming into my head. And despite evidence to the contrary, it would appear that I have matured, because instead of wanting to sling the words “I know you are but what am I?” at my siblings it got me thinking about the importance of comparison data for putting data into context and turning it into evidence.

Here’s what I mean. My husband Bret and I were snow-shoeing a few weeks ago when we encountered this really great and seemingly really tall snowman. Bret sidled up to the snowman and I snapped a picture.

When we got home and looked at the picture the snowman was in fact pretty tall — well, he was taller than my 5’5″ husband.

But then I added pro-basketball player Shaquille O’Neill to the photo. Okay Mr. Snowman, you’re taller than Bret, but compared to 7’1″ tall Shaq you are just a big old snowball.

“I know you are but what am I?”

On a whim I Googled “how tall is Pee-wee Herman?” Pee-wee Herman is 5’10” (it was on his arrest report). Who knew? The snowman and Pee-wee were the same height.

Then I Googled “average height of American men” and don’t you know — the average American man aged 20+ is also 5’10”!

I lined the guys up on a graph and got to thinking…Shaq is a behemoth and Bret isn’t (and although I wouldn’t have believed it, it seems that there is something average about Pee-wee Herman after all). As for Mr. Snowman, he’s tall, short or average, depending upon whom you compare him with.

Unfortunately this straightforward logic of statistical and visual comparison is all too often missing or abandoned when healthcare data is presented. The data just lays flat on the page — uninspiring. And when that happens it fails to become evidence of anything. We aren’t compelled to consider other questions, explore further or know what needs our attention and action.

Let’s go back to the dashboard example from a couple of Newsletters ago that won the Spectacularly Dreadful Design Award (it just keeps giving).

In addition to the painfully bad design and inappropriate display of data, nothing on this dashboard provides any context about the information being displayed.

“Compared with what” isn’t answered anywhere — there is no context provided for any of the data.

Are the admissions and discharges more or less than previous years? Are they over or under budget? What is the nursing workload goal? Should the nursing staff be increased or decreased? What is the nurse to patient ratio that is optimal for high quality care — what is the goal? Is the mortality rate expected or not expected for this patient population? Who is this patient population? Medical patients, intensive care, hospice? Is the length of stay greater or less than previous periods?

Without any context or comparison data this information is of absolutely no use. It is not evidence of anything. No leads can be followed for further discovery, no next steps can be taken and certainly no informed decisions or improvements to patient care can be made.

The fundamental question in analysis is “compared with what?” It can be one thing or several things, but in order to have clarity and informed decision making, data must be put into context.

Remember the other iconic thing about Pee-wee’s Playhouse? Of course you do…..”everybody knows what to do when they hear the secret word right? SCREAM REALLY LOUDLY.”

Today’s secret word is “COMPARE!”

I can’t hear you……ha!ha!