How Good Of A Clinician Are You? Let Data Be The Judge

By Jason DeCesari, PT, DPT, GCS

Physical Therapist

As clinicians and people, we are, for the most part, always seeking to improve. A search of the literature on self-improvement, management, and leadership will inevitably lead to the dictum, “What gets measured gets managed.”

Real-time knowledge of results fuels the reflection process, resulting in self-improvement when implemented correctly. This process may be very complex or very simple, but using data to measure the quality of what we do allows for growth as individual clinicians and a collective practice.

THE MEASUREMENT TREASURE TROVE: ELECTRONIC HEALTH RECORDS

The healthcare industry has transitioned to near-universal use of electronic health records.

Systems that are properly developed and aligned provide meaningful data from which actionable insights may be induced.

We, as clinicians, now have the tools to collect data from the multitudes of patients that we see each year. With the click of a button, and sometimes a bit of virtual elbow grease, we can see the average number of visits for our patients, their session duration, the types of treatment provided, and the diagnoses treated. We can also compare the outcomes for different patients based on a variety of parameters including the treating clinician, the living environment, and nearly any other factor that we would like measure. For a clinician seeking to improve their outcomes and build their clinical skills, this data is a treasure trove.

EHR DATA IN ACTION

One of the easiest ways to use this type of information to identify strengths and weakness as a clinician is to look at a breakdown of outcomes by diagnosis. This may show that 85 percent of a clinician’s treatments have a positive outcome and goal achievement in patients with Parkinson’s disease but a significantly lower success rate in patients with a primary diagnosis of low back pain.

This information can be used to say, “I am good at caring for patients with Parkinson’s, so I am going to try to treat all Parkinson’s disease cases,” or that data can be used to say, “I need to get better at caring for patients with low back pain and help my colleagues with their patients with PD.”

A practice or team within a practice has the ability to identify their “experts” and use their talents to build their team and use those experts’ talents to help build their team members and establish a stronger group than they would be as individual clinicians. Furthermore, a team or individual can identify their areas of weakness and seek further education. This can be used to build a team that can provide truly clinically excellent care.

REAL-LIFE USAGE

This data concept has been implemented in recent years by the team at FOX Rehabilitation. We have been gathering data from our EHR and using it to identify the strengths of our clinicians with different diagnoses and populations. We then identify what factors contribute to the great outcomes they achieve and apply those principles to our practice and the profession as a whole.

Most recently, we have identified factors in our patients and clinicians that are correlated with success treating the deconditioned older adult. We then used that data to train our teams to use these factors in their decision making.

Beyond that subset of patients, FOX is working to identify factors that predict positive outcomes to strengthen our clinical decision making as a practice. On a smaller scale, an individual can gather information about their own outcomes and assess their own performance. This allows change at the practice level and an individual basis. Going forward, we are committed to continuing our processes of gathering and analyzing data in order to improve  our outcomes and better serve the patients we treat.

FOR THOSE WITH LESS DATA

Not every clinician will be fortunate to have this information at their fingertips. That does not mean that they cannot use data to identify their strengths and elevate the quality of the care they provide.

A clinician can also find their own strengths and identify areas for improvement by studying their own patients. Any clinician can identify a population or diagnoses they are struggling with, search the literature for new treatment ideas, and implement the appropriate ideas with a patient.

Next, they need only keep the rest of their treatment the same way as they normally would and compare the results. If this patient seems to be doing better, the clinician can consider using this new strategy with others and assessing the results. As the body of work grows, a clinician may find that they have uncovered a valuable tool to help patients achieve their goals. This method of testing new strategies with the patients we treat feeds into another useful tool for improving outcomes.

THE POWER OF LOOKING BACK TO MOVE FORWARD

Reflection has been identified as a needed characteristic of experts in almost every field that requires clinical decision making. Our own literature has demonstrated the importance of reflective practice in the development of expertise, and yet many of us lack the tools to implement this valuable practice.

There are two easy to implement methods of implementing reflection in clinical practice that anyone can use. 1: This is more formal, using a journal to track clinical thought over time and look back at the questions and problems dealt with and avoiding repeating the same mistakes. 2: This is informal and can be done daily without any change to your routine. Each day on the drive home from work, a clinician can think of a treatment session from the day and ask themselves:

• Was this session productive in working toward the patient’s goals?
• Did I provide a session to my patient that met or exceeded the value expected?
• What changes could I make to improve the next session?

In doing this, a clinician is forcing themselves to think about the care they provide and assess ways to make it better. This isn’t dissimilar to a quarterback watching game film or a teacher grading papers. It is an opportunity to assess performance and improve.

If we all take these tools, make ourselves and each other better, and give our best to our patients, our profession will continue to grow and be valued by our society.