Comments on: Gruen Tenders Endorsed by House of Representatives Standing Committee - Shock!

By: Club Troppo » Atul Gawande

Club Troppo » Atul Gawande — Fri, 08 Jun 2007 10:59:20 +0000

[...] I read his book I wrote to Gawande and told him of the Gruen Tender. He was very positive and intrigued by it and we exchanged some emails on who might be interested [...]

By: James Farrell

James Farrell — Wed, 07 Feb 2007 02:44:44 +0000

I wonder if Michael, like me, is still reeling from the finale episode of Bodies on the ABC last night. But I think that the issue of quantitative performance indicators in general, and their effects on the quality of services, is in principle separate from the problem of inflated promises that Nicholas is trying to solve. Essentially he is just trying to fix an information assymmetry by devising a system that provides more information.

By: Nicholas Gruen

Nicholas Gruen — Tue, 06 Feb 2007 23:54:02 +0000

Michael, it’s not a proposal for league tables. Please get your mind around what the proposal is before slagging it off. Then we can have a debate about what is proposed, not something else. There is a lot wrong with the British star rating system.

By: michael

michael — Tue, 06 Feb 2007 13:18:14 +0000

If you want to see how league tables work in the UK read this.
My point is that we just don’t need league tables - hospitals are already top heavy with administrators and managers auditing, measuring, reporting and regulating anything that moves. Surprised there’s any room left for the clinical staff.
Hospitals need to be driven by the clinical needs of local communities not some statistical beauty contest. They need funding, not league tables.

By: Nicholas Gruen

Nicholas Gruen — Tue, 06 Feb 2007 11:30:50 +0000

Wrong Michael. Think about it (ie the claim in your first sentence) a bit more. Each service provider gets to offer whatever ‘bid’ they think is warranted given the nature of the situation. Their ‘ranking’ in a tender is a function of
1) the accuracy of past prognoses - whatever they are. If they get harder cases they don’t get penalised - unless their past prognoses have been unusually optimistic.
2) their estimate of the prognosis in this particular case.

So there’s no bias towards anyone other than those who are too optimistic in their prognoses. Over time they’ll find their further prognoses downgraded by the extent of their past optimism.

By: michael

michael — Tue, 06 Feb 2007 11:00:35 +0000

So a specialist centre that deals with people who have more severe disease will get a poor ranking. Yet more bureaucratic bullshit for doctors to deal with. No wonder hospitals employ more and more pen pushers to measure everything. What is this obsession with monitoring process? Do you really think doctors and other healthcare staff will be motivated to do better with this kind of ‘metric’? Just pay them more money, give them the right facilities and let them get on with the job.