We’ve seen sports teams full of All-Stars who don’t win games. These All-Stars score the most points and block the most shots. And yet their teams lose, repeatedly.
Medicine has its All-Stars; with scorecards to prove it. But, who elevates the care delivered by the entire team? This is hard to measure.
The Scorecard
Who is the best physician?
| Physician A | Physician B |
| Sees the most patients. | Sees the fewest patients. |
| Has the fewest deaths. | Has the most deaths. |
| Has the lowest cost. | Has the highest cost. |
The answer: You cannot tell from this data.
Look at any health care scorecard and you might think you can identify the best. However, the data is incomplete. We have an opportunity before we make decisions to step back and consider what the data shows, and what it does not.
The Lost Physician All-Stars
We have colleagues who elevate our game. These individuals may get lost in the statistical dashboards that compare us. Conversely, scorecard leaders may bring us down.
- Physician A picks and chooses the easiest patients. They are cynical and difficult to work with—and they monopolize resources.
- Physician B cares for the most complex patients and is the first physician the nurses go to during times of difficulty. They educate staff, students, and patients. They elevate care the moment they step on to the floor.
Some of the statistical laggards are our most valuable players.
Plus-Minus
Plus-Minus is a sports statistic. It measures a player’s impact on the game by measuring the difference between their team’s total scoring vs. the opponent’s total scoring when they are in the game. When a high plus-minus player is in the game, the team scores more points than opponents and the team is more likely to win. On the other hand, a low plus-minus player may score the most individual points but sink the team.
Data is Incomplete.
It’s hard to calculate plus-minus. But, we must consider it.
There is bias in the measured and nuance in the unmeasured. We need to challenge data—to step back and think about what is not being measured; what is missing. This exploration improves the care we provide. As we seek what is missing, we gain a broader perspective. We make better decisions.
Look for the unmeasured All-Stars. Whenever, we present comparative data we need to ask: “What is the plus-minus?”