The Wire, the much lauded detective drama set in Baltimore, Maryland, US, goes beyond the usual limits of a police procedural and turns instead into a penetrating portrayal of the modern American city, examining everything from the roots of urban poverty to the education system.
One of The Wire’s greatest achievements is showing how large organisations and bureaucracies often use statistics for their own ends.
The police department, City Hall and the Education Board are consistently shown to employ inventive ways to make it seem as if they are doing a better job than they actually are.
To use the lingo of the show itself, they are “juking the stats”.
In one series arc, a reduction of 14 per cent in major crimes is achieved almost overnight by a senior police commander who allows unhampered drug trading to occur on one street, creating a “mini Amsterdam” in the process.
Series creator, and former crime reporter, David Simon, clearly feels strongly about the issue, which he feels is not just limited to the Baltimore setting of the show, but a modern malaise.
“You show me anything that depicts institutional progress in America, school test scores, crime stats, arrest reports, arrest stats, anything that a politician can run on, anything that somebody can get a promotion on,” he says.
“And as soon as you invent that statistical category, 50 people in that institution will be at work trying to figure out a way to make it look as if progress is actually occurring when actually no progress is.”
In this context, it is interesting to note that HealthStat, a system used for measuring the performance of Irish hospitals, is based on CitiStat, a performance analytical tool pioneered in the very city whose misuse of statistics Simon so forensically dissected in The Wire – Baltimore.
While it would be an outrageous leap to associate HealthStat with the levels of political and institutional corruption portrayed in a television show, even one as esteemed and authentic as The Wire, Simon’s comments are worth thinking about in an Irish healthcare context.
Collecting better data has taken on increased importance over the last couple of years.
It is viewed as a key driver in introducing efficiencies at a time of budgetary cutbacks.
Nowhere is this better seen than in the work of the Special Delivery Unit (SDU).
In a recent media presentation, Dr Martin Connor, showed how new IT systems, which have improved the response of managers and health professionals to patient flow, have helped reduce hospital waiting lists and the number of people waiting in emergency departments.
Plans are also underway to move towards patient level monitoring of emergency departments, which will give a more accurate representation of the patient journey than measuring trolley numbers.
But vigilance is required in assessing these figures.
As reported in IMN last week, new research has labeled Hospital Inpatient Enquiry (HIPE) data as “fundamentally flawed”, due to considerable discrepancies between HIPE data and a hospital’s own procedural database.
Also, the report on coronary death rates at Roscommon County Hospital and other emergency departments (EDs) across the country is to be finalised shortly.
The report was called for after a local hospital action group raised concerns over the accuracy of statistics given by Health
Minister James Reilly, which said the Hospital had four times the cardiac mortality rate of Galway University Hospital.
These statistics were quoted in order to justify the removal of ED services at Roscommon in July of this year.
Before Christmas, the Minister came under pressure to justify why the list operated by the National Treatment Fund for the SDU (the Primary Targeting List), for patients waiting over 12 months, is calculated on a different basis to the list offered by the HSE in its performance reports.
And returning to HealthStat, no hospital has been graded red for poor performance since July.
While this could be attributed to the interventions by the SDU, which became operational that month, the question remains as to how such substantial performance improvements have been achieved at such a challenging time for many facilities, who have clearly been struggling to deal with greatly diminished financial resources?
The emphasis placed by the Minister and Dr Connor on improving the quality of health statistics is admirable, and appears already to be yielding results (see http://bit.ly/ycBSRF).
But we should continue to push for openness in the production of figures to ensure the decisions made in the health system are evidence based and transparent, and that any progress claimed is properly documented.
To turn a popular phrase from The Wire on its head, the provision of providing better quality healthcare to patients is no “game”.
Image courtesy of Picture Perfect Rose, Creative Commons
