How do we know if we are providing high-quality care? The answer to this question is sought by a multitude of parties: patients, clinicians, educators, legislators, and insurance companies. Unfortunately, it’s not easy to determine. There is no single score or report that provides a definitive benchmark of quality, but various measures can help paint the picture. One of the measures garnering a lot of attention is outcome tools.

我們如何知道我們是否提供高質量的護理 ？ 眾多團體都在尋找這個問題的答案：患者，臨床醫生，教育者，立法者和保險公司。 不幸的是，這并不容易確定。 沒有單一的分數或報告可以提供確定的質量基準，但是各種測量方法可以幫助您了解情況。 引起廣泛關注的措施之一是結果工具。

成果數據的價值和好處 (The Value and Benefits of Outcomes Data)

Outcome tools provide value in many areas. We can use them to:

成果工具可在許多領域提供價值。 我們可以使用它們來：

• track information and then disseminate it to employees;
  跟蹤信息，然后將其傳播給員工；
• integrate quality data into the culture of our organizations;
  將質量數據整合到我們組織的文化中；
• develop continuing education courses and seminars;
  開展繼續教育課程和研討會；
• facilitate conference participation and research projects;
  促進會議參與和研究項目；
• guide mentorship, residency, and fellowship programs;
  指導指導，居留和研究金計劃；
• support marketing efforts; and
  支持營銷工作； 和
• develop quality improvement initiatives to improve recruitment and employee retention.
  制定質量改進計劃，以改善招聘和員工保留率。

Outcome tools have practice-wide benefits as well. At PT Solutions, for example, we use our outcomes data to:

結果工具在整個實踐中也有好處。 例如，在PT Solutions，我們將結果數據用于：

• foster research collaborations with universities;
  促進與大學的研究合作；
• negotiate with payers; and
  與付款人協商； 和
• educate the public.
  教育公眾。

Imagine how much influence we could have if the whole profession joined together and used outcomes data with a unified approach?

想象一下，如果整個行業聯合起來并以統一的方式使用結果數據，我們將產生多大的影響？

While outcome tools are valuable and definitely represent a piece of the care quality puzzle, they are often met with resistance by clinicians. Outcome tools can elicit negative emotional reactions, as clinicians may feel attacked and scrutinized. As Danielle Ofri wrote in What Doctors Feel, “the desired practical outcome is smothered by the emotion cost.” While this is certainly true if the outcomes are treated as the only indicator of clinical quality, writing them off completely can remove objective data and accountability from the care equation.

盡管結局工具很有價值，并且肯定代表了護理質量難題的一部分，但臨床醫生經常會遇到抵制。 結果工具會引起負面的情緒React，因為臨床醫生可能會感到受到攻擊和審查。 正如丹妮爾·奧夫里(Danielle Ofri)在《 什么醫生的感覺 》中寫道，“期望的實際結果被情感成本所扼殺”。 如果將結果視為臨床質量的唯一指標，則肯定是正確的，但完全銷毀這些結果可能會從護理等式中刪除客觀數據和問責制。

數據分析中的偏見 (Bias in Data Analysis)

Unfortunately, we are bound to be heavily biased in our assessments of care quality. I experienced this challenge at PT Solutions, where I serve as the National Director of Quality and Research. In 2015, we rolled out Focus on Therapeutic Outcomes (FOTO), a system of outcome measures, to track clinical outcomes and patient satisfaction. Unfortunately, it was not a smooth undertaking.

不幸的是，我們在對護理質量的評估中必將有很大的偏見。 我在PT Solutions擔任國家質量和研究部主任時經歷了這一挑戰。 2015年，我們推出了“關注治療結果”(FOTO)這一結果評估系統，以追蹤臨床結果和患者滿意度 。 不幸的是，這不是一件容易的事。

I immediately sought to discover and correct the issue, as I knew we gave high-quality care. While recognizing we always have room for improvement, the results we were obtaining were not consistent with our other quality metrics, such as cancellation rates, online reviews, and patient-generated referrals.

我知道我們提供了高質量的護理，所以我立即尋求發現并糾正問題。 盡管認識到我們總是有改進的余地，但我們獲得的結果與我們的其他質量指標(例如取消率，在線評論和患者生成的推薦人)不一致。

What I found is that the rapid rollout of FOTO resulted in a poor understanding of how to use the tool. Clinics were failing to complete surveys at regular intervals, especially on or near discharge. This resulted in a large “days between status and discharge” value. We treated patients for 10 visits, but the final score obtained was on visit six. Essentially, we were treating patients and improving them without getting proper credit in our outcome scores. I spent months beating the drum that the tool was being used incorrectly. Enter the law of unintended consequences.

我發現FOTO的快速推出導致對如何使用該工具的理解不深。 診所未能定期完成調查，尤其是出院時或臨近出院時。 這導致了很大的“狀態到排放之間的天數”值。 我們對患者進行了10次訪視，但最終得分為6次訪視。 從本質上講，我們在治療患者并改善他們的能力時并未獲得對結果評分的適當認可。 我花了幾個月的時間毆打鼓，說該工具使用不當。 輸入意想不到的后果的法律。

By placing a large emphasis on our incorrect use of the tool, I created a narrative that quickly became a convenient excuse when results plateaued — any poor outcomes or satisfaction values from that day forward were attributed to an issue with the surveys themselves. At this point, I started seeking alternative explanations and strategies to improve our outcomes processes.

通過重點強調我們對工具的不正確使用，我創建了一種敘述，當結果停滯不前時便Swift成為一種方便的借口-從那天起任何差勁的結果或滿意度值都歸因于調查本身的問題。 在這一點上，我開始尋求替代性的解釋和策略來改善我們的結果流程。

I started researching and reading about decision-making and critical thinking. Soon, I stumbled across one of the most influential books I have ever read. Thinking, Fast and Slow by Daniel Kahneman opened my eyes to the world of biases and cognitive fallacies. The pieces fell into place, and I started to understand many of the issues impeding the use of quality data.

我開始研究和閱讀有關決策和批判性思維的文章。 很快，我偶然發現了我讀過的最有影響力的書之一。 丹尼爾·卡尼曼(Daniel Kahneman)的《 思考，快與慢》讓我看到了偏見和認知謬論的世界。 各個部分就位了，我開始理解許多阻礙質量數據使用的問題。

Now, I’ll walk through the key cognitive fallacies our practice has encountered in our attempt to improve our use of outcomes and satisfaction data. I have fallen victim to each of these and can attest to their power. The goal is not to abolish these biases — after all, it’s impossible to rid ourselves of them completely — but rather to generate awareness so we can more effectively recognize and navigate these cognitive traps.

現在，我將逐步介紹我們的實踐在嘗試改進成果和滿意度數據的使用中遇到的主要認知謬誤。 我已經成為每個人的犧牲品，可以證明他們的力量。 目的不是要消除這些偏見—畢竟，不可能完全擺脫它們—而是要產生意識，以便我們可以更有效地識別和克服這些認知陷阱。

確認偏差：支持既定信念 (Confirmation Bias: Supporting Established Beliefs)

The first bias to address is arguably the most common. Confirmation bias is when people seek data that are likely to support the beliefs they currently hold. We focus on what we know and neglect what we do not — which makes us overly confident in our beliefs. In the clinical world, this commonly occurs when supporting our treatment decisions. A quick PubMed search often reveals a host of studies supporting my viewpoint. So, I just conveniently ignore the ones refuting it. We see similar approaches regarding quality metrics.

解決的第一個偏見可以說是最常見的。 確認偏差是指人們尋找可能支持他們目前持有的信念的數據。 我們專注于我們所知道的而忽略了我們所不知道的-這使我們對自己的信念過于自信。 在臨床領域，這通常在支持我們的治療決策時發生。 快速的PubMed搜索通常會發現許多支持我觀點的研究。 因此，我只是方便地忽略了那些反駁它的人。 我們看到有關質量指標的類似方法。

As clinicians, we will naturally defend our treatment decisions and clinical quality. We don’t go into work thinking, “Today my aim is to be exceptionally mediocre at treating.” Therefore, when looking at quality data, we are likely to focus on the information that supports our current beliefs: “I don’t care what FOTO may say; look at how low my cancellation rate is!” This is exacerbated when adding new measures — like our practice did with the rollout of FOTO — as it invites additional cognitive fallacies.

作為臨床醫生，我們自然會捍衛我們的治療決策和臨床質量。 我們不投入工作思考，“今天我的目標是在治療方面表現平庸。” 因此，在查看質量數據時，我們可能會關注支持我們當前信念的信息：“我不在乎FOTO會說什么； 看看我的取消率有多低！” 當添加新的措施時(如我們在FOTO推出時的做法那樣)，這種情況會加劇，因為這會引起其他認知方面的謬論。

理論導致的失明：堅持一種思維方式 (Theory-Induced Blindness: Clinging to One Way of Thinking)

Theory-induced blindness, a term coined by Daniel Kahneman, essentially means that once you have accepted a theory and used it as a tool in your thinking, it is extraordinarily difficult to notice its flaws. Our theoretical beliefs are robust, and it takes much more than one embarrassing finding for established theories to be seriously questioned. If I have accepted certain quality measures (like the cancellation rate or the number of patient-generated referrals), I am more likely to cling to those. This remains true even if new data comes to light that calls into question previous beliefs. We see this when clinicians fail to adopt new treatments or assessments because they have had success with previously accepted approaches. Changing how we conduct and assess our job is uncomfortable and difficult. This is exacerbated if we are working with limited information.

理論性失明是Daniel Kahneman創造的一個術語，從本質上講意味著，一旦您接受了一種理論并將其用作思考的工具，就很難發現其缺陷。 我們的理論信念是有力的，要對既有理論進行認真質疑，不僅僅需要一個令人尷尬的發現。 如果我接受了某些質量衡量標準(例如取消率或患者生成的轉診數)，則我更有可能堅持執行這些措施。 即使新數據曝光并質疑先前的信念，情況依然如此。 當臨床醫生由于采用先前接受的方法取得成功而未能采用新的治療方法或評估方法時，我們會看到這種情況。 改變我們的行為方式和評估工作是不舒服和困難的。 如果我們只使用有限的信息，則會加劇這種情況。

可用性偏差：僅使用容易獲得的信息 (Availability Bias: Using Only the Information that Comes Easily)

Compounding the issues of confirmation bias and theory-induced blindness is a failure to procure all relevant information. It’s very easy for us to cherry-pick information, both intentionally and unintentionally. The availability bias is the process of passing judgment by the ease with which instances come to mind. If we constantly assess our cancellation rate or our visits per referral, then those numbers will more easily come to mind. If practice leaders frequently refer to those same metrics, then their perceived importance will increase. Another piece of the availability bias is knowing when to draw conclusions.

使確認偏差和理論上的盲目性問題復雜化，是無法獲得所有相關信息的問題。 對于我們而言，有意和無意地挑選信息非常容易。 可用性偏差是通過想到實例的難易程度來進行判斷的過程。 如果我們不斷評估取消率或每次轉診的造訪次數，那么更容易想到這些數字。 如果業務負責人經常引用這些相同的指標，那么他們的重要性就會提高。 可用性偏差的另一個原因是知道何時得出結論。

I employed an availability bias when I was hyper-focused on the FOTO data for one of our flagship clinics. Following months of training and no discernible improvement in the outcomes data, I was certain there was an issue in the quality of care. However, once I looked at the entire picture and recognized our great cancellation rate, visits per referral, self-discharge rate, patient-generated referrals, Net Promoter Score? (NPS?), online reviews, and patient satisfaction numbers, I had to concede that clinical quality was not a concern. As it turned out, a single clinician was artificially impacting the scores by prematurely closing cases in FOTO to avoid the hassle of collecting and monitoring outcomes data. So, we must always ask ourselves, “Do I have all the information necessary to draw a conclusion?”

當我過度關注我們一家旗艦診所的FOTO數據時，我采用了可用性偏差。 經過幾個月的培訓，結果數據沒有明顯改善，我確信護理質量存在問題。 但是，一旦我查看了整個圖片并意識到我們的取消率，每次轉診的造訪率，自我出院率，患者產生的轉診， Net PromoterScore?(NPS?) ，在線評論和患者滿意度數字，我就不得不承認臨床質量不是問題。 事實證明，只有一名臨床醫生通過過早關閉FOTO中的案例來人為地影響評分，以避免麻煩的收集和監視結果數據。 因此，我們必須始終問自己：“我是否擁有得出結論所必需的所有信息？”

暈輪效應：過分依賴第一印象 (The Halo Effect: Relying Too Heavily on First Impressions)

The second issue we faced regarding available information was the halo effect. The halo effect is when we increase the weight of first impressions, sometimes to the point that subsequent information is mostly wasted. It can affect subsequent performance assessments. How does this pertain to outcomes?

關于可用信息，我們面臨的第二個問題是光環效應。 暈輪效應是當我們增加第一印象的權重時，有時甚至會浪費大量后續信息。 它可能會影響后續的績效評估。 這與結果如何相關？

An example of the halo effect is assuming all clinicians in your practice — simply because you hired them — provide high-quality care, even if you have not seen them treat or reviewed their metrics. Even as we gain more information through co-treating and training, the initial conclusion drawn during the hiring process heavily influences our perception. Assuming we are great and the tool is wrong will stunt clinical development.

暈輪效應的一個例子是，假設您未曾見過所有臨床醫生(只是因為您雇用了他們)就提供了高質量的護理，即使您沒有看到他們對待或評估過他們的指標。 即使我們通過共同處理和培訓獲得更多信息，但在招聘過程中得出的初步結論仍會嚴重影響我們的看法。 假設我們很棒并且工具錯誤，則會阻礙臨床發展。

沉沒成本謬論：利用先前的投資來證明未來的努力 (The Sunk-Cost Fallacy: Using Previous Investment to Justify Future Efforts)

As you will notice, this progression is akin to the five stages of grief. Let’s now explore three biases that comprise the search for excuses. The first is the sunk-cost fallacy. This occurs when individuals continue a behavior or endeavor as a result of previously invested resources (time, money, or effort), regardless of the outcome. In rehab therapy, we often see this when clinicians cling to a particular treatment approach — regardless of the efficacy and literature support — because of previously invested resources. It can blind our acceptance of outcomes, as we assume the number of resources invested should be proportional to the quality of care.

您會注意到，這種進展類似于悲傷的五個階段。 現在，讓我們探索構成找借口的三個偏見。 首先是沉沒成本的謬論 。 當個人由于先前投入的資源(時間，金錢或精力)而繼續行為或努力而不管結果如何時，就會發生這種情況。 在康復治療中，由于先前投入的資源，臨床醫生在堅持特定治療方法時，無論療效和文獻支持如何，我們經常會看到這種情況。 因為我們認為投入的資源數量應與護理質量成正比，這可能會使我們對結果的接受蒙蔽。

成果偏見：過于關注負面結果 (Outcome Bias: Focusing Too Heavily on Negative Results)

The second fallacy is the outcome bias. The outcome bias occurs when we blame decision-makers for good decisions that worked out poorly and give them too little credit for successful moves that appear obvious only after the fact. For example: “My cancellation rate is great because I have implemented more open and frequent communication with patients. The poor satisfaction score is outside my control. I have had a large influx of Medicaid patients and my new clinician is struggling.” Or perhaps: “Of course Sarah has great outcomes; her clinic is in an affluent area, and all of her patients are young, athletic, and seeking care during the acute stage. Meanwhile, my clinic is in a different part of town, and all my patients are in chronic pain and have been using opioids.” While these facts may be true, there is a lack of ownership, and no actionable tasks are being developed to address the outlined issues.

第二個謬誤是結果偏見 。 當我們責怪決策者做出的糟糕的決策時，就會產生結果偏見，而他們卻對成功的舉動給予過少的贊譽，這些舉動只有在事實發生之后才顯而易見。 例如：“我的取消率很高，因為我與患者進行了更加開放和頻繁的溝通。 差的滿意度得分超出了我的控制范圍。 我有大量的醫療補助患者涌入，而我的新臨床醫生正在苦苦掙扎。” 也許：“當然，莎拉有很大的成就； 她的診所在一個富裕的地區，她的所有患者都年輕，運動且在急性期就醫。 同時，我的診所在城鎮的另一部分，我的所有患者都患有慢性疼痛，并且一直在使用阿片類藥物。” 盡管這些事實可能是正確的，但缺乏所有權，并且沒有為解決所概述的問題而制定可操作的任務。

損失厭惡謬論：有利于現狀 (The Loss Aversion Fallacy: Favoring the Status Quo)

Lastly, we have the loss aversion fallacy. Loss aversion is a powerful conservative force that favors minimal departure from the status quo. We experience stronger regret if a poor outcome results from action rather than inaction. For example: “I knew I shouldn’t have discussed recent cancellations with my patient. Now they are uncomfortable and won’t come back. I should have stayed quiet.” We are more prone to seek excuses and reasons to prevent action than to seek it. When presented with poor outcomes or satisfaction data, we are less likely to implement strategies to improve the results because of loss aversion.

最后，我們有損失厭惡謬誤 。 厭惡損失是一種強大的保守力量，它傾向于盡量減少偏離現狀。 如果不采取行動而不是不采取行動導致不良結果，我們將感到更加遺憾。 例如：“我知道我不應該與患者討論最近的取消事宜。 現在他們很不舒服，不會回來。 我應該保持安靜。 我們比尋求行動更傾向于尋求借口和理由來阻止采取行動。 當呈現不良結果或滿意度數據時，由于厭惡損失，我們不太可能實施改善結果的策略。

文化與表演之間的聯系 (The Connection Between Culture and Performance)

At this point in my journey, buy-in started to take hold, but the results were inconsistent and region-specific. Ultimately, we found that culture had a substantial influence on results. The regions that were more stable, more open and honest with feedback, and more driven by internal competition consistently outperformed the others. Now that we had sufficient training in FOTO usage and cognitive bias awareness, we needed to determine which tool to use for promoting improved performance: carrots or sticks.

在我旅途中的這一點上，買入開始占上風，但是結果并不一致且針對特定地區。 最終，我們發現文化對結果有重大影響。 在那些更加穩定，更加開放和誠實的反饋以及受內部競爭推動的地區中，這些地區的表現始終優于其他地區。 既然我們已經在FOTO使用和認知偏見意識方面進行了充分的培訓，我們需要確定使用哪種工具來提高性能，即胡蘿卜還是木棍。

獎勵積極成果 (Rewarding Positive Results)

The research is clear that reward for improved performance works better than punishment for mistakes. Note that I say reward and not financial incentive. The evidence is mixed regarding the effectiveness of financial incentives compared to other types of rewards, which could include:

研究清楚地表明，提高績效的報酬要比對錯誤的懲罰更好。 請注意，我說的是獎勵，而不是金錢上的激勵 。 與其他類型的獎勵相比，關于財務獎勵的有效性的證據不一，其中包括：

• verbal or written recognition,
  口頭或書面認可，
• promotion,
  促銷，
• awards, and
  獎項，以及
• additional responsibility.
  附加責任。

However, the question is not simply a matter of how large a bonus the high-performing clinics should receive; it is whether the focus should be on the high-performing clinics or low-performing ones.

但是，問題不僅僅在于高績效診所應該獲得多少獎金。 是將重點放在績效較高的診所還是績效較低的診所。

Some of you may disagree with focusing on reward, citing your experiences with the opposite effect, but that is often a result of the regression to the mean phenomenon. If someone exceeds expectations, future results are likely to be relatively worse, despite the initial praise. The reverse is seen with unexpected dips in performance and subsequent punishment. We need to assess trends before drawing conclusions on the effectiveness of our interventions.

你們中的有些人可能會不同意以獎勵為中心，但會以相反的效果為例，但這通常是回歸到平均現象的結果 。 如果某人超出了預期，盡管最初受到贊譽，但未來的結果可能會相對較差。 相反的情況是，表現意外下降并隨后受到懲罰。 在得出干預效果的結論之前，我們需要評估趨勢。

殘酷誠實 (Getting Brutally Honest)

Once the biases have been addressed and the method of feedback has been established, it’s time to improve our outcomes assessment process and plan for the future. We need to be both reactionary and proactive. An interesting consideration is the difference in motivation between meeting goals and exceeding them.

解決了偏見并建立了反饋方法后，就該改善我們的結果評估流程并為未來計劃。 我們必須既反動又積極主動。 一個有趣的考慮是實現目標與超越目標之間動機的差異。

We work a lot harder to meet goals than to exceed them. One is the difference between success and failure while the other is the difference between success and, well, more success. We saw this with our quality data. If we meet the goal of 98% patient satisfaction, it is no longer discussed. We no longer develop plans to improve it further — despite 2% of patients remaining unhappy — and we instead focus on other issues. If the goal is not a stretch goal — something difficult but still attainable — we often fall short of our potential. Additionally, we will have a handful of clinics simply meeting the goal and a handful missing the mark. So, on average, the group is still below the goal.

為了實現目標，我們要付出更大的努力。 一個是成功與失敗之間的區別，而另一個是成功與更多成功之間的區別。 我們通過質量數據看到了這一點。 如果我們達到98％患者滿意度的目標，將不再討論。 盡管2％的患者仍然不滿意，我們不再制定進一步改善它的計劃，而是專注于其他問題。 如果目標不是一個艱巨的目標，雖然這是一個困難但仍然可以實現的目標，那么我們往往沒有達到我們的潛力。 此外，我們將有少數幾個診所僅能達到目標，而少數診所則無法實現目標。 因此，平均而言，該小組仍低于目標。

積極主動與積極主動 (Being Proactive Versus Reactive)

“Using distributional information from other ventures similar to that being forecasted is called taking an ‘outside view’ and is the cure to the planning fallacy.” — Bert Flyvbjerg

“使用來自其他合資企業的分布信息與預測的相似，這被稱為“外部觀察”，是解決計劃謬誤的良方。” —伯特·弗里夫比約

The planning fallacy was the last major hurdle we needed to clear while reshaping our culture on clinical outcomes. We needed to shift from strictly reacting to data from past treatments and start looking forward to proactively address potential concerns. The planning fallacy is the tendency to underestimate potential complications and time needed for future projects. This often occurs in patient care. We may not consider the impacts of a patient’s diet or sleep hygiene. We may not account for the influence of understaffed front offices or the time it will take a new graduate to assume a full caseload. To combat this fallacy, we need to aggregate multiple perspectives.

計劃謬誤是我們在根據臨床結果重塑文化時需要清除的最后一個主要障礙。 我們需要從對過去處理的數據嚴格React轉變為開始積極期待解決潛在問題。 計劃謬誤是低估潛在復雜性和未來項目所需時間的趨勢。 這通常在患者護理中發生。 我們可能不會考慮患者飲食或睡眠衛生的影響。 我們可能無法考慮到人手不足的前臺部門的影響，也不會考慮新畢業生承擔全部案件所需的時間。 為了克服這種謬論，我們需要匯總多種觀點。

Aggregating assessments add to the collective pool of information. This allows the decision-maker to take “the wisdom of the crowd” and formulate a more well-informed opinion. This can be accomplished at the treatment level and at the overall practice assessment level. Ask your colleagues to review a recent evaluation to look for any potential missed data, incorrect assessments, or likely future pitfalls in the prognosis and plan of care. Work as a leadership team to assess all relevant data and bring your individual perspectives to determine why a clinic or region is struggling with clinical outcomes. Regardless of the level of the issues — be it individual patient care or clinic-wide — look at the big picture. Looking at cases in isolation leads to more quick, emotionally-driven reactions.

匯總評估增加了集體信息庫。 這使決策者可以“吸取眾人的智慧”，并制定更明智的意見。 這可以在治療水平和總體實踐評估水平上完成。 要求您的同事回顧最近的評估，以尋找任何可能的數據遺漏，評估不正確或在預后和護理計劃中可能出現的陷阱。 作為領導團隊，評估所有相關數據并帶入您個人的觀點，以確定為什么診所或地區在臨床結果方面苦苦掙扎。 無論問題的嚴重性如何(無論是個人患者護理還是整個診所)，都應放眼全局。 孤立地審視案件會導致更快，更受情感驅動的React。

總結思想 (Closing Thoughts)

As Orfi pointed out in her book, outcome measures and similar quality metrics don’t provide a full understanding or measure of quality. They provide valuable information, but we cannot determine if quality care was provided solely from the outcomes data. The same can be said for patient satisfaction measures. Emotion and bias can influence a patient just as it does a clinician. For example, even if a patient’s primary issue is a long wait time prior to the appointment, the patient is likely to give a 1-star rating across the board, when the wait time has no influence on the care provided.

正如Orfi在她的書中指出的那樣， 結果量度和類似的質量量度無法提供對質量的完整理解或量度。 它們提供了有價值的信息，但是我們無法確定是否僅從結果數據中提供了優質的護理。 可以說患者滿意度測度也是如此。 情緒和偏見會像臨床醫生一樣影響患者。 例如，即使患者的主要問題是預約前的漫長等待時間，但當等待時間對所提供的護理沒有影響時，患者仍可能獲得一星評級。

In my role, quality assessment is a key responsibility. Previously, I homed in on problems and expected excellent results. I also heavily weighed outcomes data and assumed that if the numbers were poor, then the care was poor. Through reflection, feedback, and assessment, I now have a more refined understanding of the value outcomes and satisfaction data provide. I also realize I was previously mistaken in my weighing of their value, and that I caused undue stress, frustration, and potentially even shame among my colleagues. We must hold one another accountable to high-quality care, and we have a variety of tools to make assessments of said quality. But we must also ensure we do not pull each other down when making those assessments.

作為我的角色，質量評估是一項關鍵責任。 以前，我研究問題并期望獲得出色的結果。 我還對結果數據進行了權衡，并假設如果數字很差，那么護理就很差。 通過反思，反饋和評估，我現在對提供的價值結果和滿意度數據有了更精細的理解。 我還意識到我以前在權衡其價值時被誤認為是我造成了不適當的壓力，挫敗感，甚至有可能使我的同事蒙羞。 我們必須對高質量的護理負責，并且我們有多種工具可以評估所述質量。 但是，我們還必須確保在進行這些評估時，我們不會彼此拉低。

Outcome tools can provide substantial value for your practice and the profession. While we may not solely rely on outcomes to tell a story, we can maximize their value by using the tools correctly and obtaining employee buy-in. The biases I covered are not all cognitive fallacies you will run across in clinical care, but they are highly prevalent. As stated earlier, the goal is not to eliminate them, but to have an awareness and to navigate potential cognitive traps. It will take practice. There will be struggles and resistance, but it will be well worth the effort.

成果工具可以為您的實踐和專業提供實質性價值。 盡管我們可能不僅僅依靠結果來講述故事，但我們可以通過正確使用工具并獲得員工的支持來最大程度地發揮其價值。 我所涵蓋的偏見并不是您在臨床護理中會遇到的所有認知謬誤，但它們非常普遍。 如前所述，目標不是消除它們，而是要有意識并駕馭潛在的認知陷阱。 這將需要練習。 會有斗爭和抵抗，但這是值得的。

Zach is a physical therapist, researcher, and educator whose mission is to challenge the way clinicians think and close the information gap between clinicians and laypersons. Receive a biweekly newsletter containing his latest blog posts, recent research and articles on critical thinking and healthy living, and recommended books at zacharywalston.com.

扎克(Zach)是一位物理治療師 ，研究員和教育家，其任務是挑戰臨床醫生的思維方式并縮小臨床醫生與非專業人員之間的信息鴻溝。 在zacharywalston.com上每兩周接收一次新聞通訊，其中包含他的最新博客文章，近期研究和有關批判性思維和健康生活的文章以及推薦書籍。