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The Forum > Article Comments > Measuring medicos > Comments

Measuring medicos : Comments

By Andrew Leigh, published 27/3/2008

Making data on hospitals publicly available is a useful first step to spur reform.

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Whilst it is a good idea to publish the performance data of hospitals and drs, I have grave reservations as to how this is to be done.

For decades it was maintained that the hospitals in the ACT were the most expensive in Australia. Millions and millions of dollars was spent hiring consultants to try and reduce the costs of ACT hospitals.

Two separate individuals found that errors in stastical analysis explained how is apparently appeared that the ACT was expensive when compared to the average cost of all hospitals in NSW for example, even though the ACT spent less per head than NSW on health.

A NATSEM report later verified the findings of these individuals.

However prior to this report, it was maintained by politicans that the hospitals were underperforming.

Later a report into the Royal Melbourne Hospital found that the hospital excutive was more concerned about saving money than patient welfare.

It is easy to forget that successive government policies have bought our public hospital system to this point. Over a decade ago it was decided to reduce medical school intake, now as a result of the political decisions made in the past there is a dr shortage in Australia, the short term vision was that by reducing the medical intake of undergrads this would lead to monetary savings, where in fact it has had a reverse effect and the law of supply and demand has come into play.

Health performance is not a simple system, for more than three decades the numbers of public hospital beds have been reduced to less than 50% of what they were.

The graded performance of politicans and health bureacrats, would be sitting in the corner with a large D on their heads.
Posted by JamesH, Thursday, 27 March 2008 9:26:09 AM
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Natural features like the height , weight etc can be expected to be distributed in a bell shaped curve manner.But the performance of medicos should not be in bell shape simply because of the fact that they all undergo a rigorous training and after a gruelling screening they get their degrees. Therefore it is expected that their performance is almost uniform.If that is not the case, then something is wrong with medical selection and training. It is wellknown that many become doctors not to remove diseases from the society but to make money.Mostly people without an attitude for medical profession but with only a motive for making money take up medicine as a career.It is the materialistic culture of the society at large that makes doctors too to behave like this.It is a shame that people should know about the credibility of doctors before they get appointment. So much of distrust on the medicos is a sad reflection of the state of affairs.Let us create a society based on values and not money. That will set right all the ills that afflict the medical profession.
Posted by Ezhil, Thursday, 27 March 2008 3:00:46 PM
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We, the punters, pay for it. Therefore its performance should be accountable to we the punters. Irrespective of whatever service it is that is paid for by taxpayers' money.
Posted by HenryVIII, Thursday, 27 March 2008 4:59:41 PM
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I sit here very perplexed and am trying to get my head around all this. I think we are talking about quality of care here and that in itself is quite subjective.

I am curious as to what is to actually be measured- using the medico's as an example. O.k.- measuring infection rates post op (for surgeons), mortality rates (for all medico's- except palliative care) etc. are fairly basic. How does the qualitative data figure into all this considering qualitative date is usually subjective. I would certainly hope that underachieving/poor performing doctors, nurses etc... would be managed locally by the medical/nursing director.

Now if we are talking about consultants- particularily in private hospitals just the money and power they wield will ensure that no MEANINGFUL measuring of their performance will ever take place.

Now looking at the big picture I firmly believe that all hospitals (public and private) need to be upfront about their particular strengths and hopefully have no alarming weaknesses. On the whole, our health care system is pretty darn good and it really performs brilliantly when serious life threatening cases are presented. They do the very best they can with the scarce resources they have.

Our well paid hospital executives have the concepts of benchmarking and the development of centres of excellence well and truly under control. Therefore, intrinsic to this would be the variables that would reflect the performance of medico's , nurses, hospitality and all the other range of services. This then acts as a continuous improvement initiative.

At the end of the day I remain quite skeptical of all stats anyway. As they say, there are lies, dammed lies then there's statistics.
Posted by TammyJo, Thursday, 27 March 2008 11:16:51 PM
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The bell-curve, Andrew?

Ouch. It is so much the wrong analogy as to be physically painful to contemplate.

I've had this discussion in business, dozens of times. Most often it is put forward by managers who subscribe to the "keep firing until morale improves" school of thinking.

"Every year, look at the top ten percent on your staff, and give them a trip to Bermuda. Paid for by the amount you save by firing the lowest-performing ten percent"

Sounds all very butch, doesn't it? It's the bell curve at work - as Andrew says, "[i]n the case of the medical profession, the same pattern holds". At any one time, the appearance of brilliance at one end, failure at the other.

But let's examine the reality behind it. Starting with its impact on business.

Picture the bell curve in your mind, and remove the ten percent of losers on the left-hand-side. How does the curve look now? Has it changed at all? If not, why not - according to the theory, there will always be "a few people who do very well or very badly"

OK, now what? Do you go out and recruit to fill up the missing ten percent? Of course you do, otherwise you simply proved that you didn't need the people in the first place.

Are they guaranteed to be better than those you fired? If not, what do you do? Re-fire and re-hire?

Translated into the health practitioner arena it all sounds relatively harmless. The lower part of the graph gets the most attention. There is always a need to raise standards, which is totally laudable.

But as soon as you use a bell curve, you stigmatize one segment of the medical profession, simply because they form a statistical function.

There's nothing wrong with publishing statistics on performance of doctors, hospitals or teachers and schools. It has been accomplished both successfully and controversially in other countries.

But if you look for a solution that relies for its implementation on the existence of a bell curve, the cure may well prove to be worse than the disease.
Posted by Pericles, Friday, 28 March 2008 12:35:58 PM
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I agree there will always be a bell curve. Simply chopping off the tail of the curve will make only some difference as there is much random variation of the measurement parameters over time. This would not apply to say a parameter like height.
But I find doctors so bored with my problems I would say they are all substandard. They choose to enter a profession dealing with mostly mundane problems, but do not coonsider the consequences quite often. That they score well in the relatively simple Year 12 examinations in order to enter their course scares me more in that they wil simply be more likely to crave intellectual satisfaction.
Posted by savoir68, Friday, 28 March 2008 2:13:05 PM
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