Data, data everywhere - but is it telling us what we need to know?

The health services in my part of the world are about to be supplied with more and better data, courtesy of a recent state-wide review of quality and safety. This is a good thing, if course – but if that’s all it took to create great care, well… The way data are reported, and the mindset of those who rely on reports to govern the quality of care, determine whether the hours spent preparing and discussing the information are worthwhile, or wasted. In my experience there are five (at least) distinct data report types at the highest levels of governance that differently influence how governing bodies respond to the information, and the impact on care. Which one is yours?
The Work of Art: the report presentation is so dazzling and multi-factorial that the board just sits back and admires it. Anything that looks this impressive must be good! And any quality manager and executive who can produce it must know what they’re talking about. No need for scrutiny. The result? A superficial understanding of the quality of care and a false sense of security. May lead to nasty surprises and lack of understanding and appropriate response when a sub-optimal care issue bursts the bubble.

The Terminator: a relentless focus on the things that go wrong. The emphasis is on key risks and compliance breaches. The board doesn’t realise there are many other aspects of care that are equally important to monitor, discuss and improve. The result? Many blind spots about the true quality of care, and other issues of importance to consumers and clinicians are ignored. Key risks may be well managed, but there’s little significant improvement in overall care.

The Rinse and Repeat: the same stuff is reported over and over and over… useful or not, often with more or less the same ‘average’ results. Data are used for reassurance that everything is OK, rather than to inform a drive towards excellence. The board may be frustrated, but not know how to ask for a broader view of the quality of care provided, or for significant improvements to be made. The result? Mediocre care may be seen as acceptable or normal, and a narrow view of what constitutes high quality care is perpetuated.

The Politician: reporting is designed to draw board attention away from results that indicate that all is not well. ‘Nothing to see here – and if there were, we’d have it under control.’ Frequently accompanied by ‘boards should stay out of operations’. The result? May contribute to catastrophic failures, severe harm and generally poor care, and associated dereliction of governance duty.

The Action Hero: reporting is organised to inform and guide the action required to achieve and maintain high quality care. Action heroes know they can’t save everyone at once, and the data are crafted to help the board prioritise precious resources to maximise impact where it counts – at point of care. As with all action heroes, sometimes action is taken precipitously, or not where it’s needed, particularly if the action hero is employed without their trusty ‘understanding of variation and complexity’ side-kick. The result? A shared and balanced view of the components of high quality care, are actively monitored, managed and improved; with occasional reactive and wasted actions which don’t help anyone improve anything.


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