Friday, October 13, 2006

Self Assessment Vs Customer Assessment

Home angioplasty kit

No blog yesterday as I took my Dad to have his angioplasty.

Interestingly, it was the same day that the new Healthcare Commission hospital ratings were published. And as we got ready to leave for the hospital, who should pop up on the Today programme but the very consultant in charge of the very bit of the very hospital we were heading for.

The hospital trust had been three-star rated under the previous system, and we were relieved to hear it was still rated "excellent" for "quality of services" - one of only 6.4% of all English hospitals. We were even more relieved when the consultant proudly highlighted the brand new angiography unit where we were going.

But the new rating system also includes a score for "use of resources", and there the hospital had been rated "weak". Should we be worried?

There was no time to think about it yesterday, but having now investigated:
  • The scores are largely based on self-assessment- which raises all the usual issues. My Dad's consultant may be very happy with his new kit and get along famously with his staff, but we want to know is what's he like on the needle? How many punters has he lost?
  • When these scoring systems were first established, we were all given to understand it was to help everyone monitor how well hospitals do their primary job - ie making sick people well. Bolting on a whole great section about use of financial resources may help the Department of Health's name and shame campaign, but it doesn't actually help patients
  • No less than 41.2% of acute hospital trusts are rated "weak" in their management of resources. That's a helluvalot. And what it underscores is that this is not a personnel problem of a few crap managers: this is a systemic issue which requires a systemic solution

The bottom line is that these ratings are not meant for us customers: they are yet another instrument of top-down management. And the irony is that they highlight just how hopeless that approach is.

PS My Dad's treatment seems to have gone very well, and we've both been highly impressed with the facilities and the staff. The only wrinkle is that although they had intended riddling out two arteries, after some difficulty getting the flue brushes up the first one, they decided to stick at one. They told him that might well do the trick, but they could always come back to the other one later. Now, did they do that for medical reasons- ie they didn't want to put an 82 year old through too much riddling at one go? Or was his table time up, and they need to improve that weak resource management score? And if so, who'll bear the cost of a second go? They're known as perverse incentives.

No comments:

Post a Comment