10. Poor Competence is Hidden
Knowledge of poor provider competency, especially among surgeons, is well known among medical staff, operating room nurses and techs. Yet it's unclear whether most, or even if, any hospitals have a system to curtail that physician's practice until remedial training shows sufficient improvement.
On the contrary, the usual course of business is to stay quiet, and let malpractice insurers and lawsuits weed out the inadequate providers, eventually. The reason: There's fear the poor performer might file a claim against colleagues claiming restraint of trade.
11. There are Too Many Measures
How many is too many? Let me start counting them. There are measures under the Patient Protection and Affordable Care Act that carry financial penalties that eventually will total as much as 6% of a hospital's federal reimbursement. There are private registry measures and federal measures to obtain meaningful use incentive payments.
There are pay-for-reporting measures, emergency department speed-of-care measures, surgical measures, and process measures. There are private measures from third party non-profit organizations that rank structural improvement initiatives, such as computerized physician order entry systems.
Panzer and colleagues sum up their findings by saying that "although the current state of healthcare is, on occasion, disorganized, inefficient, confusing and misleading, it is better now than prior to the Institute of Medicine's reports To Err Is Human and Crossing the Quality Chasm, when many incorrectly assumed that patients were uniformly safe and care delivery was always efficient and reliable."
If that's true, and things are better, the fact that we now measure such things is certainly the reason. But we need to get much better at it, in a way that people can understand.