Don’t Let Data Get in the Way of Good Judgment

There was an interesting article in the April 2012 issue of Harvard Business Review (Good Data Won’t Guarantee Good Decisions, by Shvetank Shah, Andrew Horne, and Jaime Capellá) that I think has relevancy to post-acute/long-term care providers.  Specifically, insights there can be useful in better understanding the significant clinical and operational challenges associated with developing the type of IT infrastructure that will help those organizations demonstrate real value as participants in integrated care delivery models.

About the Article
The authors are part of the leadership team at the Corporate Executive Board and they share some of what was learned through development of a proprietary tool used to assess the ability of employees to, “find and analyze relevant information.”  They call this the, Insight IQ, and through researching 5,000 employees at 22 global companies they stratified those employees into three types:
     Unquestioning Empiricists: Trust analysis over judgment
     Visceral Decision Makers: Go exclusively with their gut
     Informed Skeptics: Balance judgment and analysis

They argue that the Informed Skeptics are, “best equipped to make good decisions,”  but that only 38% of employees – and 50% of senior managers – fell into this group. Their research also uncovered four problem areas that represent obstacles to achieving better ROI on IT expenditures to develop data analysis:
     Analytical skills are concentrated in too few employees
     IT needs to spend more time on the “I” and less on the“T”
     Reliable information exists, but it’s hard to locate
     Business executives don’t manage information as well
        as they manage talent, capital and brand.

Implications for PA/LTC Providers
As I have written in this space previously (and in other publications), PA/LTC providers face a challenging Catch-22 with respect to Information Technology: how to make prudent investments that position them to be competitive in a world of integrated care delivery without subverting scarce resources during a period of tremendous financial pressure.  In making such investments it is critically important to fully understand and anticipate how future IT functionality will enhance clinical and operational capabilities.

To really create demonstrable value as part of an integrated care delivery network it will not be sufficient to collect, assess, analyze and report data collected through an EHR/EMR system.  Those providers seeking to gain a distinct competitive advantage through IT capabilities will also need to demonstrate how their IT infrastructure supports tangible achievements, e.g., greater patient activation, operational efficiencies and improved productivity, higher stakeholder and constituency satisfaction scores and lower rates of hospital readmissions.

As I wrote in my recently published white paper: Strategic Planning and Positioning for Healthcare Reform,
     Data becomes Information when it is organized
     Information becomes Knowledge when it is analyzed, and
     Knowledge becomes Wisdom when it is synthesized.

The stakes are very high for PA/LTC providers entering the new world of integrated care delivery.  IT investment is a foregone certainty of participation – and with that comes the tremendous risk of not achieving the necessary ROI.  As the article points out, “investments in analytics can be useless, even harmful, unless employees can incorporate [those analytics] into complex decision making.”

And there are few industries where the complex decision making of employees carries as much importance (and risk) as in healthcare.  When developing your organization’s IT Strategy, therefore, it is very important to do so in a way that sufficiently recognizes and incorporates operational and clinical understanding.

Policy Implications
There is a lesson here, too, for public policy initiatives seeking to drive wider adoption of Evidence-Based Healthcare (EBH) and Evidence-Based Medicine (EBM). Direct caregivers – and in particular physicians – are being pressured to make greater use of EBH/EBM.  We see this in the regulatory platform of the Shared Savings Program (i.e., Medicare ACOs).  We see it in how the Insurance Exchanges are being built.  And we see it in how Minimum Essential Benefits have been defined.

I believe most physicians rightly view themselves as Informed Skeptics: balancing available data with their practice experience.  I think where very often a policy disconnect occurs is when physicians try to paint policymakers with the broad brush of being Unquestioning Empiricists: seeking to supplant physician judgment with mandated decision trees.  In response (retaliation) then, policymakers will often argue that physicians’ Visceral Decision-Making is used as a cover for the economic benefits of fee-for-service based medicine.

Of course, reality as usual, lies somewhere in the middle – beyond the interests of political campaigning.  I have always argued against mandated third-party protocols (i.e., those not created and implemented by healthcare providers) because I believe the Visceral Decision Maker brings more to the table than the authors’ research necessarily implies.  I am mindful of Malcolm Gladwell’s book, Blink, in which he explains the importance of rapid cognition and intuition – and how these capabilities are based on a lifetime of experience that exists in our subconscious.

But the key takeaway here, from a policy perspective, is the importance of going beyond the “data,” which constitutes the evidence in EBH/EBM, and understanding how data will (can) be used in provider decision-making.  The same caution that applies to organizations of being at risk of data getting in the way of good decision making thus applies equally to the development of effective public policy.

What do you think?

  ~ Sparky