As high achievers, physicians have been monitoring their performance for as long as they can remember. And if you give physicians a metric, they are likely to pay close attention and feel responsible for it.
But too often in the contemporary health care landscape, piling metric upon metric becomes the default solution for driving performance in health systems.
This unwelcome trend has led to physicians being held responsible for too many metrics that they cannot—and should not be expected to—reasonably manage, according to R. John Sawyer, PhD. He is a neuropsychologist at Ochsner Health who works with physicians and clinical teams struggling with burnout and job stress in his role as medical director of professional staff experience at Ochsner’s Office of Professional Well-Being.
Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“Metrics are important. It’s like with school—we need grades or we’re probably not going to study,” Sawyer said in an interview with the AMA. Similarly, performance metrics in health care are important.
“You’ve got to have a target if you’re going to know what to go for,” Sawyer said. At the same time, he and his colleagues came to see that health care has developed “a culture of way too many metrics—that all of a sudden, physicians feel accountable for metrics they can’t influence.”
If doctors are given a metric to gauge their performance, “they’re going to want to do well on it,” Sawyer noted. “And if they don’t, it’s going to be distressing.”
This raises the question: Which metrics are really important for physicians and which are not worth physicians’ valuable attention, time and effort?
Piggybacking on that question is, “Can and should a physician even be responsible for this metric? If not, why default to them instead of another team member?” Sawyer said. “One example is patient-experience scores."
Physicians too often are “being rated on stuff like parking or food in the hospital—that they have no ability to affect,” he said. “Something that we need to think about is to what extent is the physician influencing that metric versus someone else, and should they even be accountable to it because they’re not able to influence it.
Health systems, he said, should have a process to remove and refine metrics alongside efforts to add new ones because it’s all about “metrics that matter over metric madness.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
Identify what physicians can control
One example of a metric for which physicians may improperly be held accountable is message timeliness—did you respond within 24 hours?
While the intention of this metric is to show a health system is responsive and, in turn, make the patients happy, which is good for business, does that solely rest on the physician’s shoulders?
“Being really clear about who is responsible for a metric—and refining it—is key,” Sawyer said.
Beyond that, metrics that matter for physicians include the patient’s experience with their doctor—do they feel like they’re being cared for, and that they’re getting an explanation of their symptoms? Another metric would be “the quality of care that is delivered either in the hospital or in the clinic,” he said.
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Align where metrics are shared
But the push to get beyond metric madness is about more than scrapping the ones for which doctors don’t have a meaningful role, Sawyer said. It is also about using metrics that acknowledge that health care is a team sport.
“We want to be aligned where metrics are shared, so we don’t feel like it’s just one person’s responsibility,” Sawyer said. For example, “if I were to give you a D grade and you had no influence over it, there’s a cost to you psychologically—it is frustrating to see that when you have no control over that.”
“The intention around having shared goals is that people are aligned,” he said, noting the flip side that “sometimes with shared goals, if we have no control over it, then it can also create resentment.”
That is why “we need to look at both sides of metric responsibility,” Sawyer said. “So, what do we need to really be aligned on? And then what can we do to make sure we’re not feeling as if we’re blamed for stuff that we don’t have any control over?”
Within a health system, other examples of metrics for which physicians have limited control include ones that gauge whether a patient is able to be seen within a certain number of days or how easy it is to schedule an appointment. In such practice settings, physicians are relying on their teammates within the health system for those scheduling tasks.
Work is ongoing
While the effort to ditch metric madness is a work in progress at Ochsner Health, Sawyer notes it is something they continue to think about with every decision they make around metrics.
But more needs to be done.
“I would like to have conversations around what metrics should go away and what are things that can be refined,” Sawyer said. “Because usually when we add a metric, we’re not thinking about what we need to take away.”
“That is a hard question in a meeting, but it is an important one,” he said.
Discover more from Sawyer about how to keep some things “out of sight, out of mind” to help doctors.
Download the 2024 AMA Joy in Medicine™ magazine (log into your AMA account to view) to see whether your organization is part of the prestigious group of 130 organizations across 35 states that are currently recognized for their dedication to physician well-being.
