I recently purchased a vehicle. That transaction is still at the forefront of my mind as I have spent a lot of time reflecting back on my decision making process.
First, consider the complexity of the decision being made. I had to integrate my set of preferences, needs and wants with a set of constraints (e.g. budget) and available features to arrive at a decision that will, hopefully, maximize my “outcome”, which will be reflected in my “satisfaction” with my purchase. Oh, and I want to spend as little money as possible. Sound familiar?
Next, consider the volume of data that went into making this decision. I stopped counting at 27 variables that I used to finalize my choice. Many of these variables were based on personal interaction with the vehicle. I incorporated my objective and subjective assessment of the vehicle into consideration based on viewing it in the showroom, taking it for a test drive, and picturing how I could use the vehicle in my everyday life.
In essence, I gave the car a physical exam.
While those factors weighed heavily in my final decision, they were not the only considerations. I also examined fuel consumption, safety ratings, went online to read comparison reviews with other vehicles, past performance of earlier models, engine specifications, trim options, available upgrades, accessories, colour options, and so on.
In other words, I relied on independent third party assessors, and I benchmarked it against other vehicles.
I think that it’s safe to say it would have been impossible for me to personally capture each of those data points without making that single decision my full time job and, most likely, going bankrupt. It would have been equally foolish to delegate a third party to collect all of the information on my behalf. After all, how can I trust someone else to assess my preference for handling?
Think of how much more difficult it would be for me to achieve an optimal outcome if all of that external information was unavailable. Imagine there were no crash test safety ratings, or highway fuel consumption numbers, or Consumer Reports comparison reviews, or historical performance results, or engine specifications, or so on. Making a “good decision” without such information to guide me would be virtually impossible.
Now imagine how different the automotive industry would be today if we didn’t have those information sources. Think of the innovations that would never have materialized without the recognition that there was a gap that needed addressing: daytime running lights, air bags, rear middle break light, hands free Bluetooth, crumple zones, auto dimming rear-view mirrors, driver seat memory programming, ….
Compare this fairly routine and innocuous decision against how healthcare is delivered. While the physical exam is sacrosanct and well integrated into healthcare transactions, what about the other elements: external assessment, benchmarking, and outcome assessment? How is that data integrated into the thousands of healthcare transactions that occur every day that have far more serious implications than how satisfied I am with my vehicle?
In Alberta, we have invested in building a data asset in bone and joint health that is becoming the envy of Canada. We have spent the last several years building an information system that integrates an impressive amount of data relevant to MSK care. We started with hip and knee arthroplasty, but are quickly expanding into hip fracture care and will be incorporating other MSK areas imminently. The repository integrates data from about 20 different sources that span the entire continuum of care, and captures information on pre-, peri-, and post-operative transactions and outcomes. Dozens of variables have been captured on more than 110,000 elective arthroplasty episodes of care.
One of the Institute’s goals is to mobilize this information to improve clinical and operational decision making. To date we have leveraged this data to support planning efforts, to model the impact of potential changes in care, to measure intended and unintended consequences of changes in care guidelines, to inform continuous improvement activities (at the physician, site, zone, and provincial level), and to measure variability in care delivery, processes, and outcomes.
The data serves as the platform unto which we mobilize improvement initiatives. However, the data alone cannot answer the questions that inevitably arise from careful examination. Answers require good data, sound methodology, and appropriate context.
We are privileged to collaborate with passionate and motivated individuals at clinics and hospitals across the province dedicated to using data to drive improvement. Through this partnership, we can leverage the data system that has been developed to walk the full improvement life cycle: from identification of opportunities for improvement, to investigation of root causes, the planning and execution of improvement initiatives, to studying the intended and unintended consequences.
Alberta is building a learning system.