emDOCs Podcast – Episode 95: The Metric That Really Matters

Whose measure of success are we talking about?

Question: What is it about performance metrics, patient satisfaction scores, and quality measures that induces a collective groan amongst clinicians?

Answer: When you’re asked to perform to metrics, you’re being judged by someone else’s measure of success.

History hasn’t been kind to quality measures

Recent history is replete with heavy-handed quality measures ultimately being found useless, potentially harmful, or discordant with the complexity of providing care.

A few examples… pain management (1, 2), patient satisfaction (1, 2), targeted infection reporting (1, 2), and time to antibiotics for pneumonia (1, 2, 3).

Metrics for the sake of metrics

Not that metrics are all bad, some might actually help. But they’re still something imposed on you (unless your group creates its own).

I can remember a C-suite executive coming to our group saying,

“You guys need to have more metrics.”

“OK, which ones are important to admin? What do we want to achieve with the metrics?”

“I don’t know, but you should have some.”

It’s not always so farcical, but it can feel that way.

Enter, the metric that matters.

What if there were a quality metric that evaluated YOUR experience?

If tomorrow, CMS came out with a new pay-for-performance metric that tied hospital reimbursement with clinician work satisfaction, what do you think would happen?

The hospital would move heaven and earth to improve your satisfaction scores.

Maybe your group or hospital has something to this effect and, if so, embrace it.

If not, make your own.

The Quality of Shift Metric

You probably have a sense of this: shifts can range anywhere between great, good, neutral, bad, and ugly. 

If most of your shifts are good/great, you likely feel positively about your job. If they’re mostly bad/ugly, you might feel more pessimistic.

Quality of shift is a vital metric to track, but it’s rarely measured. It’s hard to improve something unless you’re actively measuring it.

(Hat Tip to Leon Adelman on our most recent pod for inspiring the QSM idea)

How to use a Quality of Shift Metric

Measure

Rate each shift on your overall experience (a month’s worth of work is a good place to start). The specifics of how you rate the day aren’t important, it just has to work for you and be consistently applied.

It can be a 1-10 scale, 1-5, you can even use the Wong-Baker happy face → frowny face scale.

How you rate the shift is purely subjective.

Record

With each quality of shift rating, note what contributed to that experience. Is there something major that sticks out in your mind?

You can do this in a spreadsheet, Notion, the notes app on your phone, or paper – it doesn’t matter.

What matters is that you can easily access it and record the data at the end of shift.

Forgive the off kilter language. It was an emotional dump.

Trend

Once you have the data, look for trends. Were there consistent elements that were associated with ✅ positively and ❌ negatively rated shifts?

For the positives, what is in your control to amplify?

For the negatives, what is in your control to address?

Sometimes when it seems there’s nothing we can do, there actually is. 

For example, “All of my shifts that I rated as bad were crazy busy. There’s nothing I can do about that!”

Yes and no.

You can’t control the influx, but you can control how you approach it, how you document, your own internal triage, team communication.

Do one thing

Make a single change.

There might be 10 issues you can address. Great! You have room to grow. But only tackle one step at a time.

If you try to do too much or change your entire approach, it can lead to an even worse experience.

Once you’ve committed to making the single change, continue rating your shifts and see what you notice. The change you put in place is an experiment. Think of it as the new variable.

What goes well, what could go better, and how can you tweak it? 

If that feels like too much

If measuring the quality of shift doesn’t resonate with you, pick something else that does.

There’s so much invested in this job: not just the sunk costs of education and training, but time, attention, and energy. What happens in the emergency department impacts your life outside the emergency department. It’s worth it to put your own practice under the microscope. As the saying goes, don’t just work in your job, work on your job. 

Be well, my friends. And keep on rocking.