Measurement Systems, Brilliant Processes, and Exceptional Results in Healthcare: Untapped Potentials of Person-Centered Outcome Metrology for Cultivating Trust

Abstract

AbstractAn historic shift in focus on the quality and person-centeredness of health care has occurred in the last two decades. Accounts of results produced from reinvigorated attention to the measurement, management, and improvement of the outcomes of health care show that much has been learned, and much remains to be done. This article proposes that causes of the failure to replicate in health care the benefits of “lean” methods lie in persistent inattention to measurement fundamentals. These fundamentals must extend beyond mathematical and technical issues to the social, economic, and political processes involved in constituting trustworthy performance measurement systems. Successful “lean” implementations will follow only when duly diligent investments in these fundamentals are undertaken. Absent those investments, average people will not be able to leverage brilliant processes to produce exceptional outcomes, and we will remain stuck with broken processes in which even brilliant people can produce only flawed results. The methodological shift in policy and practice prescribed by the authors of the chapters in this book moves away from prioritizing the objectivity of data in centrally planned and executed statistical modeling, and toward scientific models that prioritize the objectivity of substantive and invariant unit quantities. The chapters in this book describe scientific modeling’s bottom-up, emergent and evolving standards for mass customized comparability. Though the technical aspects of the scientific modeling perspective are well established in health care outcomes measurement, operationalization of the social, economic, and political aspects required for creating new degrees of trust in health care institutions remains at a nascent stage of development. Potentials for extending everyday thinking in new directions offer hope for achieving previously unattained levels of efficacy in health care improvement efforts.