My jaw dropped. I tried to bite my tongue, but for those of you who know me, you know I failed. Here I sat, in a meeting in the late 1990's, and I couldn't believe my ears. The hospital was focusing on becoming ISO certified. (In my mind, this was supposed to mean that the services provided met some quality standard.) One defined standard referenced conformity in documentation. I simply asked, "So, how does filling in all the required areas in documentation mean that patients actually get better?" Without a pause or contemplating my question, the director of rehabilitation responded, "Everyone gets better."
"I beg to differ. I know I've treated patients who don't improve," was my reply. "We can't implement some quality standard if we don't even measure what results actually happen." The director squirmed and that's when I knew the director had no clue what he was really doing. He was just going through the motions to get certified by focusing on processes and assuming patients improved. He didn't have the capability to really think about what quality entailed. He tossed up his hands, raised his voice and stated, "no one else is doing it."
As Porter et al. highlighted earlier this year, measuring health care quality has historically focused on processes. For some reason, just as my previous rehabilitation director thought, measuring processes equated to quality care. Value in the health care world isn't focused on dotting i's and crossing t's. Value is focused on results. In order to succeed, the results of care will need to be known.
Speaking of results... in the rehabilitation world, the results that matter are how the person changed as a result of the care provided. The main way to know is to hear from the patient. If patient-reported outcomes are the gold standard for measuring outcomes, the health care world has a big learning curve. As you can see in the diagram, very little focus has been on patient-reported outcomes. At some point providers will need to embrace the patient's perspective when it comes to measuring results.
The third challenge when focusing on value is due to information being in silos. Typically, most providers who really are analyzing outcomes via patient self-report measures will only have data for their own silo of care. To really know value requires additional information. Providers need to know what happened prior to the episode of care AND what happened during the year following the episode of care. The barrier is the lack of collaboration and maybe even a slight lack of trust between payers and providers. When claims information is readily available for analysis, care pathways favoring valuable services will develop.
FOTO provides National Quality Forum endorsed measures. FOTO measures are included in the less than 2% of patient reported outcomes that Michael Porter highlighted. Patients seek rehabilitation services because they need to improve their function. FOTO can help you measure and manage the functional change that happens due to your services. Please talk to Judy Holder about how FOTO can help.