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Analytic Wars I Have Known

Change comes hard for most folks.   In the world of healthcare, this is especially true.  Sometimes change only occurs when the pain of the present outweighs the fear of the unknown.  Sometimes change takes place with new leadership bringing new goals.  But the most effective change occurs through discernment of a better way of doing things.   But one thing is for sure, when individuals are faced with change, the situation occasionally gets confrontational.  Battle lines are drawn, positions become defended, and a general condition of obstruction sets in.   Welcome to the Analytic Wars I have known.

Ammunition for the Analytic Wars comes from the data.  Whose data is correct and will drive future decisions?  Whose data will be discredited, banished from the kingdom?  Who owns the data anyway?  Major weapon systems for the Analytic Wars are the sophisticated business intelligence tools now readily available.  Enterprise BI systems are the battleships, capable of completely changing organization strategy, with desktop solutions being small arms, usually only good for defending a single department, not the entire hospital. 

To illustrate this point, allow me to share an allegoric war story.

In a major medical center in the Midwest, the data analytics team was trying to understand why there was so much variation among physician practice patterns as shown by the total cost of admission for a defined set of diagnoses.    For the first time, a dashboard had been established and it showed just that: the total cost of care broken out at the individual physician level.  Feeling empowered, the analytic staff was ready to go to battle at an upcoming Utilization Review committee.  By getting time on the Utilization Review Committee agenda with insightful information about how to improve the quality of care, the administrative staff was ready for the assault. 

When it came time at the UR Committee for the report, the analysts proudly showed their dashboard in a full frontal attack maneuver.   Stunned by the barrage, the physicians present at the meeting unanimously protested and tried the standard defense tactic of “the data must be wrong.” Wrong because there was no way that their patients were not receiving top notch care for the medical conditions presented.  How could the data possibly be right?  And the cost of care surely must include areas where consulting physicians had routinely ordered expensive diagnostic testing and that shouldn’t be attributed to the attending physicians.  Those costs were out of their control – in this case, they were just hapless participants in the silos of care.

But the rules are the rules and as the attending physician, they were on the hook for explaining the cost of care.   An uncomfortable siege set in where all eyes were glued to the dashboard, each side looking for data points that supported their position.  

After what seemed like hours, the physicians abruptly changed tactics and pulled a bold flanking maneuver with a full display of righteous indignation challenging the audacity of these analysts to look at their data without their permission or knowledge.  Who owns this data anyway?  Shouldn’t they be responsible to ensure its veracity? 

Physicians have been taught to respect the data, based on the condition of the patient as shown through data; after all, that’s how medical decisions are made.   Everyone believes the latest lab value, but put all those data points together, and there must be some sort of conspiracy if the outcomes don’t look right.

Sound familiar in your industry?  Switch the players, change the setting, and this scenario is played out over and over in many organizations today.  Healthcare is simply exploding with additional data from EMRs and digital devices, both recording and generating data.   So it’s only natural that with all this new data, better care is expected.

When presented with negative feedback about performance, it’s human nature to go through the cycle of anger, denial and ultimately acceptance.   Improvement invariably follows. 

Ever since the first computer was installed in the basement of the hospital or some dank finance office, disbelieving and discontented grumblings over data quality have been brewing.  But unlike real wars, these skirmishes rarely result in physical damages.  Without these pitched battles over the truth, progress in patient care simply doesn’t occur.   So in many ways, these confrontations are a necessary part of the improvement process.   The insight that flows from the data drives us to higher levels of performance.

As we all do battle each and every day, let’s keep in mind we have the same goal.   Performance improvement always works in every industry.  Keep you data clean and your powder dry, the next big insight is right around the corner.  

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