The secret of quality is love

love handsA physician and founder of the study of quality in health care, Avedis Donabedianwas a towering figure in the field. He developed what is known as Donabedian’s triad, which states that quality can be measured by looking at outcomes, processes and structures (how the work was organized).

In 2000, shortly before he died, Avedis Donabedian was asked for his final thoughts on quality.

“What this hard-nosed scientist answered is shocking at first, then somehow seems obvious,” writes Robert Wachter in a recent op-ed piece in The New York Times, How Measurement Fails Doctors and Teachers.

“The secret of quality is love.”

The simplicity and truth of this statement often gets lost in the nitty-gritty details of measuring quality in education. Class size, graduation rates, student test scores, teacher evaluations and class observations,  per-pupil spending, curriculum, percentage of students who further their education after high school, etc are just so many pieces of the puzzle depending on who is defining the goals and purpose of education.

In both health care and education, a deep measurement fatigue has set in.  Yes, we want everyone, whether rich or poor, to get quality health care and a quality education.  Our sense of fairness drives both quality movements. But, in the fury to measure quality there’s a sense that we are detracting from the relationship between teacher and student and between doctor and patient, which is essential to quality.

Now, instead of talking with the patient at hospital discharge, the doctor is on the computer checking off boxes listing the quality indicators du jour. In the classroom, teachers feel they have to spend most of their time preparing students for standardized tests instead of exploring ideas with them or nurturing their creativity.

Measurement is not going away.  It is too important.  But Wachter says maybe it’s time to take a breather and scale back until our understanding of measures matures. When we place too many nonessential demands on physicians and teachers (e.g. paperwork) there’s less time and opportunity for the love to flow.

“Our businesslike efforts to measure and improve quality are now blocking the altruism, indeed the love, that motivates people to enter the helping professions,” Wachter writes. “While we’re figuring out how to get better, we need to tread more lightly in assessing the work of the professionals who practice in our most human and sacred fields.”


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