October 2011 Clinical Laboratory News: Performance Inflation



Performance Inflation
Is There a Hospital that Hasn’t Won an Award?

As part of my job, I visit many hospitals throughout the U.S. Most hospitals I visit have won some sort of quality or service award and have a banner in the lobby proclaiming it. Who is giving out all these awards?

Michael Astion, MD, PhD
Editor in Chief: Patient Safety Focus
Division Chief of Laboratory Medicine, 
Seattle Children’s Hospital
Clinical Professor of Laboratory Medicine, 
University of Washington

When I was a kid, the most valuable player (MVP) was a single person who was the MVP. Sometimes the MVP was physically gifted, sometimes not. But he or she practiced harder than anyone else: shooting baskets until dark, hitting balls long after others went home, or getting up at the crack of dawn for seemingly endless laps at the pool. Kids who showed up late and practiced unenthusiastically didn’t get what today is known as the “coach’s participation award.” Even the nicest parents on the block called a kid who watched the sky instead of the ball a daydreamer, not most improved. And certainly no one considered B students gifted.

Like the euphemistically named awards given to low-achieving child athletes today, quality and service award banners gracing hospital lobbies often represent examples of performance inflation. Its appearance in healthcare settings is a manifestation of a trend in today’s society. Fueled by the desire to feel good, healthcare administrators often give the impression of superior performance by selectively using facts and statistics as marketing tools. For example, a hospital’s blood-stream infection rate goes from worst-in-class at 10% to a barely tolerable 5%. Should the hospital be a given an award for most improved because the blood-stream infection rate dropped by 50%, or should we delay the party until achievement of a reasonable target?

Happy hospital administrator receiving yet another award.

Performance inflation presents problems for both patients and institutions. For patients, it promotes use of poorly performing, and even dangerous, healthcare organizations, while conveying false confidence in those organizations. For healthcare institutions, it reduces the urgency of quality improvement. Urgency comes from measuring problems, giving priority to the ones most likely to injure patients, and then honestly confronting those harm-causing issues. By its very nature, performance inflation does not contribute to frank discussions among hospital staff that are necessary to confront patient safety risks.

In healthcare, quality gains need to be communicated throughout the organization. Such communication not only improves morale, but also begets more quality improvement. Organizational leaders, however, must carefully balance the need to affirm improved performance with the need to honestly assess and discuss where their institutions stand in the quality continuum. The quality or service award banner, like a world championship or gold medal, should be earned through painful dedication to the cause. Twisted statistics and just showing up for the game should not be the foundation for receiving an award.

Clearly, some hospitals deserve to win patient safety awards. But even in these high-performing institutions, there are likely deep, dark pockets of failure that place patients at risk. After the celebration of the quality award, hospital leaders most dedicated to quality need to migrate to that darkness. The good news is that after sitting in that darkness, it becomes easier to see the light.

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Patient Safety Focus Editorial Board

Michael Astion, MD, PhD
Seattle Children's Hospital
Seattle, Washington

Peggy A. Ahlin, BS, MT(ASCP)
Salt Lake City, Utah 

Corinne Fantz, PhD
Emory University
Atlanta, Georgia

James S. Hernandez, MD, MS
 Mayo Clinic Arizona
Scottsdale and Phoenix

Brian R. Jackson
ARUP Laboratories
Salt Lake City, Utah

Sponsored by ARUP Laboratories, Inc.