If you think for a moment about feedback, you will recognize how critical it is to improve anything, from your golf swing to the national economy.
Feedback is information about some outcome that is returned or "fed back" to the person who made the decision that produced that outcome. In the current economy, think this way: Feedback to the bankers from their making subprime loans, or Feedback to the CEOs of GM and Chrysler on the types of cars they make and how long they last.
In healthcare, it is the lack of effective feedback that produces many of our problems, from out-of-control costs to errors to shortages of doctors and nurses.
Feedback in Healthcare
In healthcare there are three groups who make decisions that affect our outcomes: providers; managers (particularly in hospitals); and regulators or legislators.
Providers of healthcare - doctors and nurses - get direct feedback on how their patients fared from their patients, their peers, professional organizations, and the legal system. All of their feedback relates to medical outcomes.
Managers get limited and indirect feedback primarily in the form of financial metrics. They also get very direct, exclusively punitive feedback from regulatory agencies on whether their institutions are in or out of compliance.
The people who create and enforce healthcare regulations get no effective feedback. Do they find hospitals out-of-compliance? Regularly. Do they get "feedback" in the form of complaints from providers and hospitals? You bet. Do they get objective, valid, scientifically sound feedback on how compliance translates to good medical outcomes? Never!
With ineffective feedback in medicine; insufficient and ineffective feedback in management of healthcare; and the complete absence of any useful feedback in healthcare regulation, how can these people learn to do better? The simple answer is: they cannot.
"Better" in health care can be either improved medical outcomes or cost reduction or both. They are NOT mutually exclusive. To get both, we need to encourage new thinking and innovation; evidence production; and most important, effective FEEDBACK.
"Effective feedback" means that there are consequences directly TO the decision maker from the outcomes they caused. Effective feedback to the bankers who made subprime loans would be that they - the bankers - lose money. In healthcare, effective feedback would mean that doctors, managers and regulators all would suffer when their patients do poorly and get rewarded when their patients do well.
What To Do:
At present, most decision makers in healthcare - medical; managerial; and regulatory - get NO effective feedback. If you want to fix healthcare, embed effective feedback in the system.
Feedback is the key to learning how to do [anything] better.
No feedback = no learning. No learning = no improvement.
If we want things to improve, there must be effective feedback.
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