6 ms·

I did some market research back in the day and there was a lot negative opinions on even attempting to measure performance based on patient outcomes because “ea

• tinokid 9y ago
  Their fear (for their own professional standing and income stream) is justified, but the objections to measuring performance are special pleading. 1) "Each patient is unique" just like "each student is unique"...but we still give standardized tests (to the grumbling of below-average teachers and administrators) 2) If the sample size is too small because the disease is rare, there may be a genuine measurement problem. If the doctor or hospital's sample size is too small but the illness is common, then they should be referring those patients to providers/facilities with the requisite experience levels.
  • zaarn 9y ago
    If a common disease has not sufficient experience in a hospital I'd argue they should pull in experts from elsewhere and try to gain the experience necessary, otherwise you just end up exporting the problem.
  • Fordrus 9y ago
    There is substantial argument that our focus on standardized testing is literally ruining the advantages traditionally associated with a Western Education. But then, perhaps I would be a "below-average" teacher, and my opinion might therefore similarly be discarded as worthless. We'll never know for certain, because I don't make a habit of boarding sinking ships - especially when I'm slated to receive blame for their sinking after boarding them. (And I did at one point very much want to enter the field of secondary school education.) (Slight modification: I won't board a sinking ship and take blame for it's sinking after the fact without some substantial advantage, such as excellent remuneration, being offered as well - teaching offers no such advantage, except perhaps self-actualization, and I can neither eat nor sleep in that.)
    • tinokid 9y ago
      Sure, bad comparison. It's consistent to support standardized rating of doctors but not teachers. Teaching exists to enrich, whereas medicine properly understood only exists to solve problems. (I find it curious that another poster takes the opposite tack, claiming that teaching exists only to maximize the financial success of students, whereas medicine has a more nuanced end. I confess to finding this position truly bizarre.)
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  • Fomite 9y ago
    Having worked a little bit on #2, even for relatively common conditions, stochasticity still plays a major role in outcomes. For example, I have a simple model that ends up showing that an ICU doing everything it's supposed to do (patient isolation, high hand hygiene compliance, perfect diagnosis, etc.) can have a four-fold difference in MRSA infections over a year by chance alone.
  • Steuard 9y ago
    For what it's worth, I've heard a whole lot of above-average teachers complain about standardized testing, too. The things that one does in a classroom to optimize standardized testing performance are often not the same things one would do to optimize creative problem solving, or independent learning, or good citizenship, none of which are captured by (existing?) standardized tests. For that matter, the things that a third-grade teacher would do to optimize third-grade standardized test scores aren't necessarily the same things that the same teacher would do to optimize twelfth-grade standardized test scores.
• phamilton 9y ago
  As someone who works in education, I find it interesting that "each case is unique" hasn't prevented outcome based metrics in education.
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  • admg 9y ago
    It really should but I think thats a much more difficult problem to politically explain why every case is unique!
  • Fordrus 9y ago
    A very simple hypothesis as to why doctors can argue this effectively but teachers cannot is that teachers are not as powerful a lobbying group as doctors. Doctors have effectively been able to defend their "turf," from hostile encroachment, while teachers have not, not because the situations do not contain substantial parallels, but rather because doctors are politically strong while teachers are politically weak.
    • StudentStuff 9y ago
      Opposition to most doctors is low, they aren't being forced to be rated by their clients, whereas most teachers have a weak union in a district with poor funding, and thus they have to contend with overloaded classes that result in poor educational outcomes that lead to most students not going on to do much with their lives. Its much easier to punch down than it is to punch up!
    • freeflight 9y ago
      The term "Gods in white" exists for a reason, many people ascribe a lot of authority and knowledge to physicians and doctors in general. Doubting your doctor's diagnosis is usually considered a rather odd thing to do and if it's a doctor of psychology it could even be interpreted as a symptom. While with teachers it's kinda the opposite; Even tho their whole job is to know and teach things, many people have a way easier time disagreeing with them straight out of principle. Wonder how much of that boils down to socialization aka in what contexts children are introduced to these professions?
• dredmorbius 9y ago
  Case mix and case severity are real concerns. Physicians (and hospitals) vary tremendously in each, and often the best physicians get the hardest cases, which, if not accounted for in metrics, make them look bad. Data are also often tremendously thin -- I've seen profiling efforts over tens of millions of patient-lives in which a given provider may only have a handful of records. That's not enough to draw strong inferences, and year-to-year variance is going to be tremendous. It also turns out that there are very strong clusterings of patterns around facilities: a senior physician or surgeon can (and does) drive practice, quality, and methods for much of the rest of the medical staff. The single best predictor of quality I recall was volume of procedures. Practice (and standardisation) help tremendously.