Comments on: Quality Measures─ Where’s the Compassion?

By: Jim Gaffney

Jim Gaffney — Mon, 17 Sep 2012 14:58:42 +0000

Joe,

Thanks you for the excellent illustration of the rewards we get in palliative care and hospice by focusing on the goals of the patient, and also by not taking ourselves too seriously.

As Mark Pfeifer points out, we do need to measure quality in palliative care quantitatively just as the rest of medical specialties do. There are, however, some measures of quality, such as the number of head pats, that we will probably never measure but that make our work so fulfilling.

By: Joe Rotella

Joe Rotella — Fri, 14 Sep 2012 17:26:58 +0000

I appreciate all the responses. Thanks Mark for posing a very central question. I do not think that hospice and palliative medicine should get a pass on quality measurement and reporting. What I think is that we should take the lead on developing, validating and promoting cross-cutting quality measures that actually drive practitioners in our field and others to practice more compassionately. For example, it’s one thing to measure how many patients with pain report relief within 48 hours and quite another thing to measure how many report that their pain was treated in a way that supports their goals and preferences. Brow-beating an opiophobic patient in pain to accept opioids right away may not be as compassionate as exploring complementary and alternative methods. We need to put the patient at the center of all our measures. It’s harder to do but more likely to drive true value (better outcomes and better patient experience and lower costs).

By: Mark Pfeifer

Mark Pfeifer — Fri, 14 Sep 2012 12:28:16 +0000

Joe and Lori,
Thank you sharing your warnings, concerns, cautions. I couldn’t agree more.

But what do you recommend should be measured to assess quality in palliative care? Or are you suggesting palliative care gets a pass? Would the public accept and promote palliative care without some quantitative measuring?

By: John Mandrola

John Mandrola — Fri, 14 Sep 2012 01:53:32 +0000

Excellent Joe.

The entire medical profession, cardiology included, is struggling to balance on the narrow precipice that is the practice of evidence-based AND compassionate care. The risk of racing towards productivity quotas and quality metrics is that we see only the finish line–the best practices. This would be a sad outcome indeed.

As you nicely point out, it’s critical to notice our greatest triumphs–those that result in getting a bald spot patted. For me, it’s often a hug or a hearty handshake or just a look of thanks. These ‘quality measures’ don’t fit so easily on spreadsheets, do they?

I feel blessed to be peripherally involved with the #hpm crowd. You guys help me to “get it.”

By: Lori Earnshaw

Lori Earnshaw — Wed, 12 Sep 2012 19:33:50 +0000

Thank you for reminding us about the “heart” of palliative care and the reason for focusing on quality improvement. I was recently reminded of a quote from Mother Theresa, “Not all of us can do great things. But we can do small things with great love.” While our profession endeavors to do “great things” with a far reach, we mustn’t forget the essence of our work, the small things we do with great love. This quality defines our profession and, if forgotten, threatens our integrity and the satisfaction that we feel as practitioners caring for our patients, families, colleagues, and other staff.