Big Data, big stories and the stones in our shoes – how neglecting the foundations can trip us up

Citation

Callanan, I. (2015), "Big Data, big stories and the stones in our shoes – how neglecting the foundations can trip us up", International Journal of Health Care Quality Assurance, Vol. 28 No. 6. https://doi.org/10.1108/IJHCQA-06-2015-0074

Big Data, big stories and the stones in our shoes – how neglecting the foundations can trip us up

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 28, Issue 6.

In this issue, we have some varied papers with familiar themes but with a common thread of data analysis that should create a foundation for more in-depth conversations in healthcare.

Some years ago, the Japanese health system configured its payment systems to attempt to reward each speciality fairly and consistently. A further reconfiguration was intended to refine the equity of payment, but according to Nakata et al., the anomalies persist. Their data analyses highlight the perversities within the Japanese surgical reimbursement system, inequities that are replicated in many other national reimbursement systems worldwide. By their analyses, cardiothoracic surgeons and other highly regarded specialists get an unfair advantage in reimbursement schemes. This feature may not be unique to Japan.

On the other end of the health resource spectrum, Islam identifies the deficiencies faced by Bangladeshi health services, with half of all available public medical posts vacant. He identifies the essential contribution of electronic technology, and in particular, the central role of the humble mobile phone in maximising efficiency in service delivery. Interestingly, he identifies the role of the phone in ensuring transparency within the service, making us reflect on how simple things can have significant unforeseen benefits.

In countries of plenty, Allison, when examining the use of electronic medication reconciliation at discharge in Tuft’s Medical Centre, has highlighted the need for constraining medical performance to reduce errors in prescribing. In a health system where significant investment in electronic patient record maintenance has taken place, it is worrying to be confronted with the essential importance of restricting medical variation, even if such restraint continues to be argued over by healthcare professionals. Readers may be familiar with work in this field, particularly by Rene Alamberti in Paris. Allison found 34 instances of at least one prescribing error within a sample of 200 prescriptions prior to the rollout of their electronic discharge medication tool. Furthermore, the error rate was similar across prescribers of differing levels of experience. The human mind, unaided, may be a dangerous tool in medicine. Electronic assistance, as shown by Allison, is significantly safer.

We are fallible beings. We depend on electronic assistance to assimilate big quantities of information. But the old adage of garbage in, garbage out, rings true when we analyse the very important building blocks of “Big Data” analysis. Natarajan et al. highlight a basic concept that we all recognise; healthcare data are not always representative of clinical work, because its generation is often for administrative purposes and not as a tool to assist frontline staff. Conversely, clinical trial data can be very accurate, but of little relevance for cost management. Now that the concept of big data is upon us, meta-analyses of data sources to create “Big Data” can be beneficial or harmful. Data staging errors and entity resolution are not concepts that we readily understand unless we are intimately involved in the management of “Big Data”, but it will be important for us to learn about these issues so that errors are not magnified. Remember the mathematics we learned in school … the probability of errors in two separate areas, a and b, is not the sum of the error (a+b) but rather, the product of the error rates (a×b). Natarajan et al. lay out a road map for us to easily understand the issues surrounding “Big Data”.

Pyrbutok et al. have outlined a detailed analysis of patient perception and experience using the SERVPERF variation of the SERVQUAL model, pioneered by Parasuranam et al. many years ago. SERVQUAL has proved itself to be a very useful model of analysing quality dimensions in healthcare, and now, the SERVPERF model has been found by the authors to identify discordances and opportunities for improvement with greater accuracy. In their sample, they found that the variation in the access opportunities taken by US citizens to avail of primary care. Hospital emergency departments attracted one-third of their sample of younger patients from college backgrounds. Such pathways are known to be the most expensive, and often the most disjointed. Primary care physicians on the other hand, were identified to be the more “caring” and consistent with longer term care opportunities, with urgent care centres occupying the middle ground. Perhaps, primary care physicians need to familiarise themselves with the concepts of advertising and branding.

Back in the acute hospital setting, important lessons can be learned when we follow the thread of consistent patient centred care. Though volumes have been written about patient experiences, it has been my experience that we get very uncomfortable when faced with the reality that the patient often comes second to organisational demands, professional autonomy and financial constraints. I wonder is there any other service industry that manages its customers with such variation. Bishop et al. bring us back to earth with their identified themes contained within the patient and family narratives surrounding safety issues in acute healthcare. They identify three themes of “being passed around”, “not having the conversation” and “the person behind the patient”. I defy any of our readers to testify to never having heard these themes before, but yet it seems we consistently need reminding of them.

We publish this paper with the memory of our former editors in mind. Let’s hope that each of us can take the lessons to heart once again as we set out to improve and assure quality in patient care.