Measuring Physicians' Quality and Performance
Adrift on Lake Wobegon
- Donald M. Berwick, MD, MPP
- Author Affiliation: Institute for Healthcare Improvement, Cambridge, Massachusetts.
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- COSTS AND COST ANALYSIS
- OUTCOME ASSESSMENT (HEALTH CARE)
- PATIENT SATISFACTION
- PAY-FOR-PERFORMANCE PROGRAMS
- PHYSICIANS
- QUALITY OF HEALTH CARE
- TASK PERFORMANCE AND ANALYSIS
In Garrison Keillor's mythical hometown, Lake Wobegon, all the women are strong, all the men are good-looking, and all the children are above average. That is, of course, impossible, at least when it comes to the children. In any given population for any defined characteristic “everyone above average” is, statistically, nonsense.
Of course, the same is true of health care. Performance on anything called “good” about the care (such as reliability, waiting times, dignity, or survival) in any defined population (such as physicians, hospitals, visits, or health plans) will follow some distribution. The shape of that distribution can be orderly (such as quasi-normal, binomial, or Poisson) or disorderly, but for sure, every member cannot be above average.
That bare fact disturbs the peace, mainly because it invites comparison. For instance, patients who need heart surgery would want to know who can do the very best for them. That curiosity also …
