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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

#221

Post by russjr08 »

finaliteration wrote: post #167
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…

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.

This is how my call center measured performance until upper management came in and shut it down. Now it’s 800s, or you’re out.

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

#222

Post by stevenwoo »

There was a counterintuitive study of obstetricians that I cannot find right now that showed that in one state over many (10?) years the ones who did the most C-sections were the best doctors - because when researchers looked at the underlying data the realized these doctors treated the patients who had the worst predicted outcomes and beat the national odds - I think they theorized that these doctors had the best ability to choose the optimal method of birth and were not afraid to choose c-section when it was necessary.

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

#223

Post by russjr08 »

emodendroket wrote: post #190
justonepost wrote: post #161

Earlier quoted context omitted.

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

I mean, in general, a hostile tactic like this is likely to get the agent to do as little as possible as he can to help you while staying within the rules. Plus in many cases the front-line agent doesn't have the permissions to do what you need anyway and has to transfer you to a "supervisor" (usually not actually one) or a retention guy to resolve your issue anyway.

I’ve even heard of some centers that are allowed to hang up on you if you try that.

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

#224

Post by fphhotchips »

swiley wrote: post #204
jpatokal wrote: post #172

Earlier quoted context omitted.

One support team I used to work with prioritized "first touch resolution" for email cases as well, so the agents would answer every case with a 16-page DYI flowchart listing every single possible problem and its resolution. KPIs are hard...

Maybe I’m weird but that’s exactly the kind of response I would want.

No, that's documentation, and it should come with the product or, in the modern era, be available online.

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

#225

Post by newfoundglory »

emodendroket wrote: post #186
newfoundglory wrote: post #157

Earlier quoted context omitted.

This is like asking why software project estimation can't just be done by looking at the size of the project to be built.

I don't see how the analogy works. The entire point is you have a medical record with objective characteristics that can be tied to the risk of any given procedure.

My entire point is that isn't true at all - you have a medical record with some objective characteristics, but it is not possible to calculate the risk of a procedure based on that information. Just like in software, we have a project requirements document with many objective characteristics and we are unable to calculate the time required based on those characteristics.

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

#226

Post by Consultant32452 »

randyrand wrote: post #181

Easily solvable. Have a person whos jobs it is to rank how likely a person is to live. He gets paid based on how accurate he is. Doctors would then be ranked as an offset from this previous mortality prediction.

This incentivizes the doctor to maximize the appearance of risk in the medical record.

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

#227

Post by natoliniak »

Buttons840 wrote: post #91
fc003153 wrote: post #73

Earlier quoted context omitted.

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

Pro tip for those targeting a high win percentage. If you win your first game (beginners luck?), then stop playing and never play again. That's what the article is describing, surgeons won't even play the game, they won't even attempt to help certain people because it might hurt their "win percentage".

another pro tip: compete only against weaker opponents (this is common in Boxing).

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

#228

Post by fricat1ve »

carbocation wrote: post #82
fricat1ve wrote: post #50

Earlier quoted context omitted.

A better way to make this claim would be to plot the mortality rates for the states over time and show that the rates in those places requiring reporting begin to diverge as the new policy is implemented.

They effectively did that: they compared public reporting states with other geographically adjacent states.

There's nothing like Boston or NYC in the control states. If the effect is as big as they seem to think--a 21% increase in mortality--that should be visible on a plot of deaths over time.

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

#229

Post by tonyedgecombe »

jpatokal wrote: post #172
finaliteration wrote: post #167

Earlier quoted context omitted.

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.

One support team I used to work with prioritized "first touch resolution" for email cases as well, so the agents would answer every case with a 16-page DYI flowchart listing every single possible problem and its resolution. KPIs are hard...

My experience is most customers can't read past the first line of a response. The idea that they can get through a 16-page flowchart seems unlikely to me. And I do sell to a mostly technical audience.

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

#230

Post by Too »

Consultant32452 wrote: post #226
randyrand wrote: post #181

Easily solvable. Have a person whos jobs it is to rank how likely a person is to live. He gets paid based on how accurate he is. Doctors would then be ranked as an offset from this previous mortality prediction.

This incentivizes the doctor to maximize the appearance of risk in the medical record.

The one doing the estimate should obviously not be the same doctor doing the surgery.
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