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Heart surgeons refuse difficult operations to avoid poor mortality ratings

telegraph.co.uk

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Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#161

Post by justonepost »

ouid wrote: post #131
emodendroket wrote: post #103

Earlier quoted context omitted.

When I was fresh out of a school I worked in a call center for a while. One of the most important metrics (and everything you did was measured) was the average length of each call. So it was common practice, when you got cases that basically were going to be long calls or ones you probably couldn't actually resolve (e.g., "I want the service back on but cannot pay"), to deliberately upset the customers so that they w…

Does this mean that I can threaten to not talk to their supervisor?

Ooh good tactic. Mention something like ‘Got all day and I’m not gonna hang up until we get this solved properly.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#162

Post by DanBC »

sky_rw wrote: post #13
aantix wrote: post #2

The subjective is always where there is value. I wish there were surgeons that would accept these challenges and colleagues would objectively assign a degree of difficulty score. And a site that aggregated such scores. I really don’t care how “friendly” a doctor is - did the get the diagnosis right? Did they improve longevity? Did they improve quality of life? Not easy to score but what everyone wants to know.

Does the NHS provide enough free market choice that anybody could take advantage of a score even if they wanted to?

It provides some. "Choose and Book" was introduced in 2004, and converted into e-referral in 2014, and it means you get a choice for most elective surgery.

https://www.nhs.uk/NHSEngland/appointment-booking/Pages/abou...

https://www.england.nhs.uk/2014/05/choose-and-book/

Most people don't have enough information to make a sensible choice; and they don't understand the information they've got.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#164

Post by brightball »

fc003153 wrote: post #73
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

I'm not so sure Goodhart's Law is correct. For example, if I target a high win percentage, is win percentage, then, not a good measure? Mortality rates are a pretty good measure for surgeons. The problem here is that they are inflating their measure by cherry picking. edit: Some measures should be targeted, the problem here is that it is done in an non genuine way

In your scenario, the equivalent for win percentage would be trying to set an easier schedule.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#165

Post by danzig13 »

sowbug wrote: post #141
danzig13 wrote: post #132

Earlier quoted context omitted.

At best it probably only identifies the people to replace.

Which is often another misguided response: https://deming.org/explore/red-bead-experiment

The measure can help you identify those willing workers by how the react to it though.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#167

Post by finaliteration »

emodendroket wrote: post #103
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

When I was fresh out of a school I worked in a call center for a while. One of the most important metrics (and everything you did was measured) was the average length of each call. So it was common practice, when you got cases that basically were going to be long calls or ones you probably couldn't actually resolve (e.g., "I want the service back on but cannot pay"), to deliberately upset the customers so that they w…

I worked in a call center, as well, but they didn’t prioritize call length as a metric/KPI. Their number one KPI was “first call resolution”, meaning even if it took an hour as long as the problem was resolved the call was considered a success. I feel like it was a much healthier way to measure call center performance.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#168

Post by mitko »

Shameless plug - I wrote an essay recently on how any metric becomes a vanity metric http://dimitarsimeonov.com/2018/03/22/the-vanity-metric-para...

Some excerpts:

- having clear, well defined metrics is the single largest driver of progress within a company

- Any metric sufficiently optimized becomes a vanity metric

- Building products is not science. What makes a good product is usually dependent on so many factors that are subject to change and evolve.

- Over time, a product no longer stands to die if these metrics degrade.

- According to EdwardTufte - people and institutions cannot keep their own score

Hope someone finds it useful!

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#169

Post by cc81 »

TheRealPomax wrote: post #48
maxerickson wrote: post #15

Earlier quoted context omitted.

A large portion of the people undergoing heart surgeries still face a high risk of death if they don't have the surgery (with the surgery bringing the chance of a longer, more comfortable life). Here's why your hot take isn't the best take: “About 30 percent of them said they had turned patients down for surgery even when they knew full well that surgery was in their best interest.”

Here's the converse of that, though: why do we think it's okay to expect a team of doctors and nurses to be okay with almost assuredly killing someone during surgery? They're not robots, "it's their job" is not an acceptable answer. Even if the surgery is in a patient's best interest, if the odds of killing them are all but guaranteed then it's most definitely not a matter of looking at the patient and rationalising…

But it does not have to be that extreme. Let us take a made up example where there are two categories of patients. One that are healthy enough that a positive outcome of surgery is almost guaranteed, almost all survive. If you operate on people like that you will have excellent stats.

However let us add someone that is really sick and will most likely die within 6 months if they don't get surgery. They are in bad shape so surgery has a 25% risk of killing them. Most patients would probably want to take that gamble but for the surgeon who operates on patients like that frequently that would mean that their stats would go from almost perfect to pretty bad. You don't want to surgery from a guy with where 10% of his patients die from heart surgery when you can get another guy where only 0.1% die.

Re: Heart surgeons refuse difficult operations to avoid poor mortality ratings

#170

Post by kolbe »

fc003153 wrote: post #73
cs702 wrote: post #30

It's Goodhart's Law in action, this time with deadly consequences: "When a measure becomes a target, it ceases to be a good measure."[a] [a] https://en.wikipedia.org/wiki/Goodhart%27s_law

I'm not so sure Goodhart's Law is correct. For example, if I target a high win percentage, is win percentage, then, not a good measure? Mortality rates are a pretty good measure for surgeons. The problem here is that they are inflating their measure by cherry picking. edit: Some measures should be targeted, the problem here is that it is done in an non genuine way

Goodhart is talking about life, not a self-contained system like a game.

>Some measures should be targeted, the problem here is that it is done in an non genuine way

The "not in a genuine way" is exactly what he's talking about.

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