Quality is Heading for Extinction. Are We Ready to Face the Void?

Just as dinosaurs became too big to roam the earth the demand for quality in health care has spawned enormous and unfathomable datasets that have outgrown their usefulness.

I can live with that if I know that the reams of raw data are being used to underpin realistic, reliable, decisions. But they’re not. Right now they’re being mined by commercial marketers who have no qualms about accurately defining quality then feeding the results into any number of apps to score everything from hospitals to doctors.

Quality is not a tangible entity and it can’t be used by health care marketers, who are unconfined by the rigors of scientific research, as the basis for informed choices.

Indeed the Internet is awash with sites dedicated to listing “top” health facilities that use a number of negative proxies to equate quality with the absence of adverse events. For example death: a top quality hospital is one where no one dies and is to be recommended.

Similarly, clinician mistakes are being conveniently substituted for the absence of quality, which is why data on patient outcomes of individual clinicians is readily available in the UK and USA.

To be fair though, even when experienced researchers examine proxies of quality measures, like hospital death rates and recordings in clinical notes, the data refuses to deliver clear answers – that’s why good research takes time.

But quality is not a tangible entity and it can’t be used by health care marketers, unconfined by the rigors of scientific research, as the basis for informed choices. Commercial sites that promise to deliver quality health offerings or a clinician who practices defensive medicine (and supposedly doesn’t make mistakes) are just not being honest. An app, no matter how clever, is incapable of interpreting complex health care data, which probably explains why clinician scoring has little effect on how patients choose their doctors.

The truth is, most of us just want our health care delivered like every other consumable product sold by an experienced seller: easy to access, good value for money, attentive after service and no defective parts, which is of course entirely unrealistic in health where adverse events are inevitable and advanced diseases such as cancer and death can’t be returned.

Wise and appropriate use of our masses of health data is going to involve jettisoning the notion of quality and leaning to live in the grey areas where our health care choices are concerned. Just like buying a pair of shoes we need to use our own experiences – how we choose to cover our feet – to help us weigh up the odds and make a the best choice, irrespective of what the seller tells us is quality.

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