In the last session we talked about what constitutes good care. We saw this could be broken up into the quality of the medical and non-medical services themselves including whether or not we carried them out correctly. The cost to those providing the care and paying for the care. And the access to care with respect to time and location. Today, let's take another perspective and then just your perspective. The perspective of those providing the care. How do you know whether or not you're running a good operation? Or if you allow me using some medical lingo. What other a vital signs that you should take when it comes to diagnosing you the work that you're doing? When you went through your professional training, you were taught to deliver great care. If the world consisted of just you and one patient, you would know exactly what to do. The science of medicine itself, establishes a number of medical measures that you can evaluate for a given patient, saying blood pressure, cholesterol levels, or body mass index. In the last session we discussed that non-medical measures, such as how happy the patient is with the food or parking could be considered as well. But the world is more complex. Now in your job, you don't just have one patient. You take care of many patients. You are in a time pressure and cannot spend as much time with each patient as you like. This is frustrating. Caring for many patients would also mean that your waiting room or your appointment book is full. And while patients complain about copays and politicians complain about rising healthcare costs, you still have tuition bills you're paying back for medical school. In fact, things are even more complicated than this. The typical patient sees many providers. Some of those are on your payroll and you have to make sure that they can, salaries get paid. Others are providing services to you such as pathology labs or imaging. You have to coordinate the care and guide the patient with a complicated maze. While everyone in healthcare wants to help patients, we should not forget about providers. When I interviewed a top executive of a boutique restaurant chain some year ago for my radio show, she told me, "I tell my managers to put employees satisfaction as their number one goal in our restaurants." When I politely corrected her implying that she for sure must have meant customer satisfaction, she insisted, "There's no way that you will get great customer service with an unhappy employee." She told me. I'm still not sure but I entirely agree with her but she certainly has a point. You cannot try to achieve customer satisfaction and other forms of performance if we do this on the back of those providing the service. So, after our first class was all about patient-centric measures, I want to take a moment to talk about provider-centric measure. A 2014 study published in the Mayo Clinic Proceedings found that 54 percent of physicians, reported at least one sign of burnout. This corresponds to a substantial increase relative to three years earlier when that number was just 45 percent. Beyond burnout, provider concerns about work life balance and stress have recently been growing. There exists some variation in medical specialties but the message is clear. The burnout rates are dramatically high and they are getting worse. We cannot continue what we're doing. I want to group performance measures into the following five buckets. There's patient centric measures, medical outcomes, medical errors, infection rates, readmission rates, waiting times (when they are clinically relevant). There are patient centric measures that are really non-medical if you think about patient satisfaction; the ambience, parking, free Wi-Fi, food. Waiting times it's more of a convenience for a patient type of argument, net promoter score, reputation scores all of those. There are operational measures third, such as patient volume, utilizations, patients-to-provider ratios, left-without-being seen rates, cancelations, no shows. There are providers centric measures; employee satisfaction, turnover, absenteeism, personal and professional growth measures. And finally, there are financial measures; operating profit, return on investment, cash. Financial measures I would argue, are the outcomes of the things that we do. If we do all other measures well, we will make money. But money is not the starting point. It is the outcome. So, what measures a performance of a healthcare operation? That is a silly question. It is like me as a patient to ask, "What measures my health?" Many things are important. You cannot manage a healthcare system from a financial perspective alone. As we saw today, the financials are only the outcome of a lot of things that we do. As we measure the performance of an operation, we cannot just collapse everything in one measure. Just like body temperature is only one way to measure the health of a patient, financial measures are only one measure to see how all operations are doing. Instead the performance of something complex as the healthcare operation is measured by a wide array of performance measures. These measures include patient centric measures. They also include measures related to the healthcare system, how many patients and how many providers we have, and all kinds of other measures that are clearly of importance.