Friday, January 25, 2008

Blog's Breakfast

Here’s a smorgasbord of our recent results. Bon appetit!

It looks like we’re back in the swing of things after the holidays. The number of backlog patients seen was really down in November and December, coinciding with many of our group being away on vacation. We have a goal of seeing 60 backlog patients every week, and we topped that last week. First time in 5 months!

Back in November, we got excited about the 3rd next available appointment times dropping. We were disappointed to see the line climb back up again. Well, here we go again. The latest 3NAA has dropped “significantly”, but will it stay down?  Stay tuned!

At our team meeting yesterday, we reviewed some preliminary results from measuring recall intervals.  For the last few weeks, we’ve been tracking how frequently our urologists recall patients for office visits. We’re recording 3, 6, and 12-month recall intervals. I was surprised to see that I had a high number of 3-month recalls. So much for setting an example!

I was a little puzzled, as I couldn’t remember asking for all these appointments to be made. Either my recollection was off (entirely possible!) or we had a glitch in our data collection.

Our data collectors track recall requests via each urologist’s dictation. Each time we see a patient, we send a letter to the referring physician summarizing that visit. At the end of the letter, we give instructions to our staff regarding whether the patient needs another visit, and when that should be.  Our data collectors tally these requests. Our project team’s intention was that only recalls for office appointments should be recorded. I wondered if there might be another source of recalls being tracked inadvertently.

Patients who have had bladder cancer undergo regular bladder examinations (cystoscopy) to detect recurrent tumors. In these cases, most urologists follow a set (i.e. traditional) schedule of cystoscopies: every 3 months for 2 years, every 6 months for 2 years, then annually. Even though I don’t see these patients in the office (cystoscopies are performed at the hospital), my letter to the referring physician (with recall instructions) does end up in my office dictation. Perhaps our data collectors had been including cystoscopy recalls with office visit recalls.

Bingo!  One data collector had and one hadn’t been doing this. So our 3-month recall rates have been inflated by the inclusion of 3-month cystoscopy recalls. We’ll start over again after making our intentions clear to the data collectors.

I learned a couple of thing from this. First, it’s healthy to be skeptical about your data. Garbage in, garbage out.

Second, people aren’t mind-readers. Our project team wanted to collect office recall data only, but we didn’t make that clear to our staff who actually collected the data. It just seemed obvious to us that it should be done that way.

When you’ve been steeped in this stuff for the last year, it’s difficult to see things from an “outside” point of view. We didn’t consider possible alternate interpretations of our instructions.

In Made to Stick – Why Some Ideas Survive and Others Die, Chip Heath and Dan Heath call this situation the “Curse of Knowledge”:
“Once we know something, we find it hard to imagine what it was like not to know it. Our knowledge has ‘cursed’ us. And it becomes difficult for us to share our knowledge with others, because we can’t readily re-create our listeners’ state of mind.”
Back to the drawing board!

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