Systems and words and meanings

By G. Rendell. Two recent conversations are in the process of melding in my mind.  (No Vulcan required.)  One of them was with an MD, and the other with a university sustainability officer. Chatting with the MD, the subject of "quality" came up.  She's a solo practitioner, working with and in -- but not as an employee of -- a large hospital.  Apparently, the hospital is intent on absorbing most or all of the solo and small group practices associated with it, under the pretext of improving quality.  I say "pretext", because their argument is that quality is a function of the number of ways a hands-on practitioner's activities get recorded and scrutinized.  The number of forms that get filled out.  The number of non-MDs passing judgment on what MDs do.  Without apparent reference to what outcomes are produced or what needs and expectations satisfied.  "Quality", in such a context, sounds perilously close to economic efficiency; the concepts aren't inherently in conflict, but neither are they inherently identical. Read more...