Were We Improving the Process or Improving the Outcome?
A group brought me a project they had been working on for several weeks.
They were trying to understand why patients were not showing up for their appointments. The no-show rate had been a persistent problem, and they had done serious work. They had mapped the process, tracked every patient touchpoint, and built out the data to show what the office was doing to address it.
The presentation was thorough. They knew how many calls had been made, how many texts had been sent, which MyChart messages had been delivered, and how many follow-up attempts had been logged. They could tell me how many times each patient had been contacted and through which channel.
I listened for a while before something started bothering me.
Everything in the room was about what the office had done. The staff had followed the process, made the calls, sent the reminders, completed the follow-ups, and documented the work. They had done everything they were supposed to do, and they had the data to prove it.
What was missing was the patient.
I don't mean the patient's information. I mean the patient's experience. Nobody in the presentation had asked what the patient said when the office called, whether the texts produced a response, or whether saying yes to the person on the phone was simply easier than explaining why they needed to cancel.
The staff had been frustrated for months because they were getting blamed for no-show rates when they had followed every step of the process. From where they sat, they had done their jobs.
They had, and that was part of the problem.
Everything they had been working on was within the office's control. They could make the calls, send the texts and MyChart messages, document each contact, and measure whether every step had been completed. If something wasn't working, they could adjust the process and measure it again.
The patient ultimately determined whether they showed up, and that had never come up.
Everything they had measured told them how well the office was doing its part. They could tell me how consistently the process was being followed, but they couldn't tell me whether any of it was changing the patient's decision to keep the appointment.
I don't think anyone was avoiding it. The project had been built around what the office could measure and what the staff could control. Whether the patient intended to show up, why they might cancel, or what would make it easier for them to keep the appointment existed outside the data the group had collected.
When I started asking what the patients actually said when someone called them, we realized we didn't know. We knew whether the call had been made and whether the appointment had been confirmed, but we didn't know much about the conversation between those two things.
They had been working to improve the process, but the outcome they were trying to change was whether the patient showed up. Those aren't the same thing, and the distinction mattered. Improving the process had given them a detailed picture of everything the office had done. Improving the outcome meant understanding something that picture couldn't show: why patients weren't showing up in the first place.
The data they needed most was the data they had never thought to collect.
What is your data actually helping you understand?
A leadership team can have detailed data about a process and still be missing what it needs to understand the outcome.
The Organizational Performance Diagnostic helps healthcare leadership teams work backward from the performance they are trying to change to examine the decisions, organizational conditions, and adaptations producing it.
If your team has a detailed picture of what the organization is doing but still can't explain why the outcome isn't changing, that's a useful place for us to start.
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