Texas Tech University Health Sciences Center
Process and Outcomes: Balancing Our Perspective

Process and Outcomes: Balancing Our Perspective

When I was a hospital administrator before I came to the Texas Tech University Health Sciences Center, I remember participating in a protected quality improvement meeting along with several physicians, nurses, pharmacists and other health care professionals. By “protected,” I mean the discussions were confidential and for the purpose of quality improvement as permitted by the federal Health Care Quality Improvement Act. We were going over our institution’s quality statistics, and the data were, for the most part, very positive.

We were particularly proud that we had met or exceeded process standards related to how patients presenting in the Emergency Department with a myocardial infarction (heart attack) were medically treated upon arrival. The standards included such things as an aspirin should be provided as well as a beta-blocker and the patient should be prepared to be taken to the cardiac catheterization lab in less than one hour.

On a particular patient, I asked how he did? In other words, what was the outcome? I had just heard that we had done all the steps correctly, but what I wanted to know is how the patient faired.The nurse presenting the data informed me that the particular patient about whom I was inquiring had died.

There were downcast eyes and nervous shuffling of paper at the response, and the reality of the situation became clear. It became very obvious to us all that we can hit the quality performance target for doing certain processes, but still not have the desired outcome. Now, I am not saying that anything was done wrong, or that all patients will survive a myocardial infarction, even with the best care. That is just not reality. Furthermore, I understand that a myocardial infarction is a life-and-death situation. I am thrilled that we, as a society, are doing a much better job. In the 1970s, nearly 40 percent of older heart attack victims who made it to the hospital never left and today that number is well below 10 percent.

However, we must match our processes with desired outcomes. Improving processes help with outcomes, but improving outcomes is our goal. Numbers do not tell the whole story. As a person with a degree in accounting, I believe in the power of numbers, but health care delivery is more than numbers. It is about people who we are privileged to serve and the outcomes of our service to them.