Curious…

training_primary_care_NHS_curiousity

A great man once told me; ‘be curious’.

He wasn’t an educated man, he grew up at a time when, for working people, there wasn’t much education around. He was not educated but became knowledgeable.

Today, there is nothing we can’t find out, by lunchtime. Google has unlocked a world of knowledge.

Our problem… we don’t know what we don’t know… but we do know how to find out.

These days, ignorance can only be lack of curiosity and laziness.

For this man, overcoming ignorance was hard work. He read the newspapers, joined a library, debating clubs, the church, the unions and the workplace. He had to put himself out, to find out. He used his curiosity.

Curiosity; a wonderful gift. We only move forward, do new stuff and better, if we are curious. Curiosity stops us looking at our feet and makes us look out to the horizon and up to the stars.

With any luck our kids are curious, before schools, work and life saps it out of them.

The man who gave me this advice was a window cleaner. He was my Dad. Curiosity drove him on, to become a manager of one of the first big Tesco super-markets.

I thought of him last week. A new report started doing the rounds. Made me curious. The clue’s in the title;

A Culture Of Openness Is Associated With Lower Mortality Rates Among 137 English National Health Service Acute Trusts.

… written by; project-HOPE, Bethesda USA. For $15 you can read the whole thing. Don’t bother.

At a time when the NHS is consumed with quality, staff morale, recruitment and treating people better… it should hit the spot.

If we treat each other better, patients will benefit. You’d like to think so. According to the research… it’s true.

They took data from 137 acute trusts, 2012-14 plus data from the staff survey, put it through the mincer and concluded;

‘… at one-point, increase in the standardised openness score was associated with a 6.48 percent reduction in hospital mortality rates. These findings have important policy implications.’

Actually, I think this is junk.

Curiosity got the better of me. I dug into the research.

The indicator they used for ‘trust performance’ is the Summary Hospital-level Mortality Indicator, the so-called SHMI;

‘This is an indicator of healthcare quality that measures whether the number of deaths in hospital, or within 30 days of patients leaving hospital, is higher or lower than you would expect.’

This is the wrong indicator for what the research set out to prove; ‘A Culture Of Openness Is Associated With Lower Mortality Rates among… Acute Trusts.’

Think about it.

It is perfectly possible for a patient to have been treated like royalty, with happy-smiley staff, only to be discharged into a miserable care home, a desolate council flat, a patchwork of meals on wheels, fifteen minute-carer-calls, or fall down the stairs and in 30 days, the hospital care is blown wide open.

Conversely, the damage done by a miserable hospital could be repaired by the skills of a Queen’s Nurse or a healthcare assistant at the top of their game.

Thirty-day survival can have everything or nothing to do with a good outcome, regardless of the openness in a hospital, or not.

Statistical voodoo. Taking the wrong data to give us the answer we all want. It’s not research its rock-n-roll… noisy and entertaining and that’s about it.

I wanted this research to be right. Because I wanted it, I nearly didn’t dig into it. I almost let it go.

But I got curious… got Googling… then I found this, going back to 2013, based on a much better measure, for this purpose, at least, Hospital Standardised Mortality Ratios HSMR;

‘… an indicator of healthcare quality that measures whether the number of deaths in hospital is higher or lower than you would expect.’

The report says;

‘… In the context of the… debate about the relationship of HSMR to hospital performance… findings of a weak correlation between staff satisfaction and HSMR are intriguing… warrant further investigation.

Whether higher staff satisfaction drives quality or merely reflects it remains unclear.’

Maybe we still don’t really know. My guess; there is a relationship but flawed research doesn’t help.

As we plan for an uncertain future, data is all we have and we must be able to rely on bright people two make it work, not just manipulate it.

I’m left curious but I do know this; some people want stuff to happen, some wish it were the case, others make it happen.

Which are you? I’m curious.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.