SPINE Volume 40, Number 13, p 1045 ©2015, Wolters Kluwer Health, Inc. All rights reserved.
HEALTH SERVICES RESEARCH
Point of View William Abdu, MD, MS
G
iven the efforts to measure all aspects of our care, identifying the variables that contribute to outcomes will allow a better understanding of drivers of satisfaction. It is a big assumption to equate satisfaction with outcome and a bigger concern to focus on improving satisfaction without focusing on functional and pain improvement. The work by Bible et al2 indicates the risk of not adjusting for baseline differences and the pitfalls of selection bias. The methods by which quality measurement data are obtained and analyzed should be with the same rigor as expected for any high-quality research. So how do we use these data on the drivers of outpatient satisfaction? Do we “teach to the test” by prescribing placebo treatment that patients expect? Do we ignore evidence-based medicine, expert opinion, and clinical practice guidelines when it doesn’t suit expectations? Do we avoid electronic medical records to have more time with patients?
Well, no. It is incumbent upon us to always do the best we can as advocates of our patients’ best interest. It may mean spending more time with our patients, not less, developing team approaches to educate, provide care, and communicate effectively, that we improve at setting expectations preoperatively, and incorporating shared decision-making processes. We know we can’t make everybody better. We must, however, always do the best we can and continue to juggle the many agendas within our control so that we can change what we measure for the better.
References
1. Harry M, Schroeder R. Six Sigma: The Breakthrough Management Strategy Revolutionizing the World’s Top Corporations. Random House; 2000. 2. Bible JE, Kay HF, Shau DN, et al. What patient characteristics could potentially affect patient satisfaction scores during spine clinic? [published online ahead of print April 2, 2015]. Spine.
From the Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Acknowledgment date: April 10, 2015. Acceptance date: April 13, 2015. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to William Abdu, MD, MS, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756; E-mail: william.a.abdu@ dartmouth.edu DOI: 10.1097/BRS.0000000000000934 Spine
www.spinejournal.com
1045
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. SPINE150001POV_LR 1045
03/06/15 5:44 AM
HEALTH SERVICES RESEARCH
Point of View William Abdu, MD, MS
G
iven the efforts to measure all aspects of our care, identifying the variables that contribute to outcomes will allow a better understanding of drivers of satisfaction. It is a big assumption to equate satisfaction with outcome and a bigger concern to focus on improving satisfaction without focusing on functional and pain improvement. The work by Bible et al2 indicates the risk of not adjusting for baseline differences and the pitfalls of selection bias. The methods by which quality measurement data are obtained and analyzed should be with the same rigor as expected for any high-quality research. So how do we use these data on the drivers of outpatient satisfaction? Do we “teach to the test” by prescribing placebo treatment that patients expect? Do we ignore evidence-based medicine, expert opinion, and clinical practice guidelines when it doesn’t suit expectations? Do we avoid electronic medical records to have more time with patients?
Well, no. It is incumbent upon us to always do the best we can as advocates of our patients’ best interest. It may mean spending more time with our patients, not less, developing team approaches to educate, provide care, and communicate effectively, that we improve at setting expectations preoperatively, and incorporating shared decision-making processes. We know we can’t make everybody better. We must, however, always do the best we can and continue to juggle the many agendas within our control so that we can change what we measure for the better.
References
1. Harry M, Schroeder R. Six Sigma: The Breakthrough Management Strategy Revolutionizing the World’s Top Corporations. Random House; 2000. 2. Bible JE, Kay HF, Shau DN, et al. What patient characteristics could potentially affect patient satisfaction scores during spine clinic? [published online ahead of print April 2, 2015]. Spine.
From the Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Acknowledgment date: April 10, 2015. Acceptance date: April 13, 2015. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to William Abdu, MD, MS, Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756; E-mail: william.a.abdu@ dartmouth.edu DOI: 10.1097/BRS.0000000000000934 Spine
www.spinejournal.com
1045
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. SPINE150001POV_LR 1045
03/06/15 5:44 AM
