Vroom Goes the Sound of Quality
Written May 28th, 2008 by Seth YoungI read Zen and the Art of Motorcycle Maintenance when I was in college. I ran across it in an old used bookstore and thought the title sounded cool. I remember standing there debating whether to buy the book, daydreaming at the very least some cute co-ed might see me reading it under a tree on campus and think I was hip. Three dollars and change later I was immersed in Robert Pirsig’s cross-country motorcycle quest into western values. Little did I know the book’s central question “What is Quality?” would then haunt me and eventually find its way into my work.
Last year the Board of Piedmont Hospital tasked me with creating a Quality transparency website. As you all know, talking about quality in abstract philosophical terms is one thing, but tackling healthcare quality is completely different thing. Today’s healthcare consumer wants empirical facts, hard numbers, percentages extended to the second decimal place. They want real accountability. At least that’s what I thought.
The Romantic Poets
In the Summer of 07 I joined our Chief Quality Officer, Leigh Hamby, MD, in making the case for a Quality site to the Board. I foretold the coming tsunami of Health 2.0. I waxed “better informed patients with health savings plans.” I waned “consumer generated healthcare” and “comparison hospital shopping on the web.” We told of government websites already reporting our quality metrics. We warned that if some negative metric got to the press there would be nothing to defend us in the court of public opinion, unless we put up our own Quality site to tell our side of the story. We also assured them a Quality site would be a good tool to motivate our staff to improve performance.
One Board member raised his hand and questioned “the wisdom of using external exposure to stimulate internal change.” It was a good point and I had no response except to unveil my beta Quality Site full of AJAX widgets, user-friendly tabs and animated graphs. The usability was sweet. The graphs looked even better. In the end, the Board agreed to let us launch our site complete with patient satisfaction scores and core measures data. We were thrilled. We would be the first hospital in our market to adopt a bleeding edge approach to healthcare marketing.
The Age of Reason
Here’s what happened next… basically nothing. Oh, I mean the staff loved it. We got tons of praise from senior leadership. Even the Board was happy. I should have been elated, but I wasn’t.
The problem was the traffic to the site wasn’t what I’d hoped. We only got a handful of visitors each week, and I realized a lot of those were probably staff checking out the clinical measures. We knew that a typical consumer’s idea of healthcare quality favored customer service over clinical data. But the visits to our patient satisfaction site did not amount to much either. After all the work and preparation, where was the tsunami of Health 2.0?
The Enlightenment
Over the next few months I tried to focus on the important details of hospital website maintenance like correcting department phone numbers, updating doctor photos and press releases, you know, the fun part of the job (not). We continued to receive positive recognition within the hospital, but every time it happened I felt somehow “transparent” about accepting the praise. The truth was in the web metrics, nobody outside our walls really cared about quality. Or did they?
One morning I got a call from Nina Montanaro, VP Marketing & Public Relations, who was very excited to tell me that she had just come from an “Executive Roundtable” where all the area hospital CEOs get together and chat about healthcare. During the meeting a CEO from another prominent health system recognized our CEO, Tim Stack, for doing the right thing and publishing our quality data on the web. He also mentioned how nice the site looked. J He strongly encouraged all the other CEOs to start publishing their data too.
At first I didn’t realize the importance of what happened. But it dawned on me that our hospital may be influencing other hospitals to start practicing healthcare differently. We had embraced transparency and begun to change healthcare in our region. Suddenly my enthusiasm for the Quality site came full circle.
Postmodernism
No small irony that Robert Pirsig’s book stemmed from his experience as a mental health patient. Back then the providers owned and interpreted all the data, unilaterally dictating treatment regimes. In Pirsig’s case it meant undergoing electroshock which split his psyche in half and left him chasing a ghost of himself cross-country on a motorcycle.
We are still very focused on case-volume in healthcare, and we sometimes forget the real ROI is about quality rather than quantity. I think this is also true of hospital website traffic. So maybe our Quality site will never draw much of a crowd and maybe Health 2.0 is more wishful hype than substance at this point. So what.
Last month we started publishing our risk adjusted mortality, surgical site infection and sepsis data. This data is the essence of transparency, though to be honest there still isn’t much traffic, no Health 2.0 tsunami. But it’s ok. Maybe the real value of it is somewhere in the long tail. Maybe it is less about how many people are visiting than who is visiting.
Like Pirsig’s quest on the open road, our quality transparency site has turned out to be as much about process as outcome, and more about the journey than the destination.
May 29th, 2008 at 9:31 pm
[...] health care Category The good folks over at Webiscope have posted a blog entry I wrote about hospital quality sites. I have decided to add them to my blogroll. For anyone who cares about healthcare web development [...]
May 30th, 2008 at 8:03 am
I have asked the question for years of those who have done what you have done regarding traffic and consumer interest and/or comprehension. While I agree that what you have done is the right thing to do, and I’d encourage any other hospital or healthcare system to do the same, I am still skeptical whether patients will care about or understand that data.
Now the HCAPS data is another story. Most studies of patients show they define “quality” as whether the nurse was nice to them and how much they had to pay. So the kinds of questions that generate the HCAPS results will have meaning for patients and should be included with the othe quality data.
Congrats on what you have done and the recognition you have received for it. Richly deserved, to be sure. Now, about those traffic numbers….
Neal
June 12th, 2008 at 9:50 am
Quality and transparency can, at times, be very difficult, especially if you have a few bad scores, which is likely to happen to everyone. I think it’s the responsibility of the hospital or physician to explain low scores in detail and inform the public of their action plan to make sure the issue is taken care of.
I also think it’s essential for a hospital to display their scores with integrity. Our main competitor located directly across the street from us recently posted some quality data that was skewed and obviously manipulated in an attempt to make their scores higher than they actually are. (They surprisingly have several low scores.) Executive Leadership at my hospital contacted me immediately to see how I planned to respond to this. I told them we would most definitely not respond to a lack of integrity. Our quality scores are not manipulated to make us look good, nor would we ever do such a thing. It would ruin our credibility. We are not putting our quality and satisfaction scores out there to manipulate people. We are posting this data so that patients will know where they can get the best care, as well as what they should and shouldn’t be concerned about when coming to Methodist.
Regarding your quality site Seth, I love how you’re able to drill down to the actual questions that were asked. Very cool!! This had to have taken a lot of hard work. I think it looks and functions very well. Great job!! What is the admin like for this? Is it difficult to update?
June 12th, 2008 at 10:26 am
Thanks for the feedback. Originally I built it using the ajax widgets that come with Dreamweaver. These are hosted on a separate server and called in with iframes. Since we get our scores from Press Ganey there is currently no way to hook into their database directly. So, I have to paste the scores in by hand. It takes about 3-4 hours per hospital per quarter to do this.
However, next month I will be migrating the system to be database/xml driven. We will receive a bulk update each quarter to dump in the database and update everything automatically. When that happens we will not only be able to drill down to the question level, we will be able to zoom in on individual service lines.
I am also in discussions with Press Ganey about opening their platform for development so that we can offer real-time quality scores and even more flexible usability. I’m sure it will take them awhile but we’ll get there.