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I'm Not a Doctor

A second opinion on the challenges and opportunities facing today's physicians.
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By Andis Robeznieks

Steering standards and guiding guidelines

12:45 pm, Apr. 6

The healthcare industry has standards—by the truckload.

It also has a multitude of measures and a googolplex of guidelines.

Among the 9,638 articles in the Modern Healthcare archives that mention the word "standards" was an item on a recent Institute of Medicine report on developing healthcare standards in the face of a disaster. Among the 10,223 stories that contain the word "measures" was a report on the National Quality Forum endorsing 30 quality-of-care measures. And, among the 2,888 reports using the word "guidelines" was a report on guidelines and principles for genomic sequencing tests.

I do not know whether anyone out there is measuring measures or trying to standardize standards, but, according to a report in the Annals of Internal Medicine, there is an international effort under way to develop guidelines for developing guidelines.

"Over recent decades, the number of guidelines developed by government and private organizations worldwide has increased exponentially," the report states. "Clinicians, patients and other stakeholders struggle with numerous and sometimes contradictory guidelines of variable quality.”

Enter the Guidelines International Network. Founded in 2002, the network includes 93 organizations and 89 individual members in 46 countries. According to the report, it maintains an online library of 7,400 documents providing information on 3,636 guidelines.

The IOM report Clinical Practice Guidelines We Can Trust, released March 23, 2011, offered eight standards for developing guidelines. A companion report, Finding What Works in Health Care: Standards for Systematic Reviews recommended 21 standards for ensuring a valid review. The Annals of Internal Medicine report came up with 11 of what it called "key components" of quality guideline development.

These included recommendations on determining the composition of a guideline-development group and the scope the guidelines will cover, and on establishing conflict-of-interest policies as well as decision-making, recommendation-review and guideline-updating processes.

While the Annals of Internal Medicine article appeared deadly serious with an earnest desire to help, it made me think of a presentation at the 2007 Healthcare Information and Management Systems Society conference where HIMSS Analytics President and CEO Dave Garets and John Glaser, then-vice president and CIO of Partners HealthCare System, gave a tongue-in-cheek presentation on "The Art of Stalling" and "The Art of Patronizing," which touched on topics such as "We Don't Need No Stinkin' Benchmarks" and how to use the "indecipherable diagram ploy."

During the "Art of Stalling" segment, Glaser talked about how to block a CEO's bad idea while making it appear that you're working on it. This included establishing a 50-member multistakeholder committee assigned to write a mission statement and setting a consensus-building policy where "a 19-1 vote should be considered a tie."

Of course, before doing that, you may need to build consensus on what is considered consensus.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.

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