Improving Care, Improving Performance, or Just Improving Numbers?

Abstract

This Open Forum reviews the literature on computerized systems that purport to either assess or improve clinical care in mental health. There is little empirical support for these claims. These limitations are in keeping with the author's own experience in developing and using such systems. In light of this evidence and experience, the author argues, nonquantitative methods of assessment can be not only complementary to use of computerized systems but possibly corrective. The author concludes with the caveat that if the only things you can change are the things you can measure, then perhaps the only things you are changing are measurements.

Demand Characteristics and Quality Improvement: Who is Fooling Whom?

“…Since the quality indicators that administrators define and measure represent their operational definitions of quality care, they are delighted when they improve. They may forget that improvement on these measures does not have a one to one relationship to improvement in clinical outcomes (Luchins 2008). So when clinicians give back to administrators the numbers they want, administrators (perhaps incorrectly) believe that the patients must be getting the care that they need.…”

The Electronic Medical Record: Optimizing Human not Computer Capabilities

“…So why should JCAHO require them and administrators believe that better completion rates represent progress? When using these measures we must distinguish between administrators' limited ability to improve care versus their much greater ability to improve numbers (Luchins 2008).…”