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A Rose By Any Other Name

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I suppose it was inevitable. CQI has invaded Art.

Continuous Quality Improvement, Quality Assurance, Assessment and Accountability, Closing the Loop. The vocabulary--and the gestalt--of the Analyticals have taken over the corporate world, manufacturing, marketing, education and now health care. PSAD--Plan, Study, Do, Act--the circle of implementing, testing, analyzing data and revising--has left those of us who prefer to experience the world in a perceptual multicolored stream, rather than flow charts and series of zero and one bits, suffering from PTSD--Post Testing Stress Disorder. We receptive perceivers used to be able to find a refuge in entertainment and the arts. But, alas, no more.

I'm not talking about how our books, films and TV shows have been studied, analyzed and dissected; broken down into components that are focus-tested and homogenized to appeal to the greatest number of dollar spenders. Yes, there are computer programs that can walk you through the process of writing a book or a screenplay--fiction as algorithm, a production line product. No, I'm referring to the explosion of talent and passion that inspired poetry, literature, paintings and other creative ventures. Fueled by alcohol (and other substances), spiced with liberal helpings of unmedicated DSM-IV mental health conditions, our history of creativity over the millennia was anything but mechanized.

And we, the audience, responded as humans, not robots. We enjoyed, we laughed, we cried, we yawned, we cheered and we booed. From our guts and our hearts. The classicists may have fine-tuned their work for their patrons, but we weren't asked to rate the symphony, when, soothed by its magic, we floated out of the concert hall. How would I be able to close my eyes and be transported to a scenic vista by the rhythms of the Grand Canyon Suite, when my hand is gripping a pencil to grade the skills of the woodwinds?

So, I practically choked on my coffee, Iced Quad Venti with Whip Skinny Caramel Macchiato, when I ran across a stunning example of how to meet the Quality Improvement (QI) requirements for the recently launched Maintenance of Certification status of my medical specialty board. In addition to a secure Board examination that tested clinical skills and knowledge, all providers seeking to "maintain their certification" have to participate in a QI program in their practices. The example given on how to implement a QI initiative didn't address quality of care, medical knowledge, surgical skills, etc. It was instead an exercise in how to decorate a doctor's waiting room!

In this example, we were encouraged to pull a team together, to survey patients about the current state of the waiting area, to solicit ideas from the QI team and the clients, to make a list of bullet points identifying each intervention and its hoped for outcome:

• New blinds! More light!
• New paint! A cleaner appearance!
• New furniture! More comfortable seats!

You get the idea. You implement the changes, and then survey your patients to see if they find the waiting room cleaner, warmer and more comfortable. If not, you keep revising your plan until you get the satisfaction ratings or outcomes you have designated. In case we didn't have a clear picture of each phase of the process, we were also presented with a colored chart that, in order, diagrammed every step along the way. With all the triangles, arrows and circles, I was flashing back to high school Geometry.

I had redecorated our own patient areas not long ago--had I broken the "new rules" by asking our building engineer to paint a mural on one wall? By hanging children's pictures in pretty frames I'd gotten at the two-for-one sale at our local framery? By opting for comfy bench seats instead of separate chairs (so our patients could take a nap)? By enlisting colleagues with decorating talents to suggest a carpet and color scheme? By not clearing the design in advance with my clients? Or by not asking them their opinion of our décor after the fact?

Yes, I know. It was only an example. But it was a telling example of how this analytical process has unfortunately diffused into all aspects of our lives. My experience, my artistic judgment, and my gut had guided me in developing a waiting room that would meet the needs of my particular patient population. Why should my experience, my artistic (or clinical, professional, or personal) judgment and the human sum of those factors, my gut, now be cast aside in favor of "data." No, I don't decry the pursuit of "evidence-based" information to help guide decision-making--but, especially for those of us who have had the benefit of years of training and experience, have we not to some extent processed a lifetime of "input" over those years in our own brains as "evidence" for our decisions? Watching the artist paint, the sculptor sculpt, the musician compose, the doctor diagnose--can we not acknowledge and value the "art" that blossoms with each of those human talents; bolstered by training, of course, but composed of something more than the sum of simple zeros and ones?

I want to stop smelling the basal stipules, pinnate leaflets, hypanthium and achenes. I want to smell the roses.

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