Measuring Ourselves

To the YSM and Alumni Communities:

“Judge Smails: Ty, what did you shoot today?
Ty: Oh judge, I don’t keep score.
Judge Smails: Then how do you measure yourself with other golfers?
Ty: By height.”

In January, in a reflection on discipline, I shared that, “To hold ourselves accountable, we must also become comfortable with sharing data about our performance.” As I have been considering the many ways in which we measure ourselves, these lines from the Harold Ramus film, Caddyshack, came to mind (an occupational hazard of having raised three sons). In his glib response, Ty Webb (Chevy Chase) captures the pitfalls of comparisons, but also the absurdity of striving to improve without measuring progress.

In the last few weeks, the Blue Ridge Institute of Medical Research rankings for National Institutes of Health (NIH) funding were released. Yale School of Medicine moved from 6th to 4th in the rankings with a 13% increase in NIH funding to $512.1 million. This is a reflection of the creativity, talent, and hard work of our investigators and of the commitment of our staff who support the submission of grants and management of the research enterprise. It is not, however, the only measure of our research enterprise or even necessarily the best. Others include bibliometric measures, such as publications in high impact journals or the number of collaborative publications or citations per publication; the number of careers launched; numbers of Howard Hughes Medical Institute investigators; members in the national academies and other national honor societies; Lasker awardees; Nobel laureates; and drugs or technologies developed. Like NIH funding, many of these are measures of inputs when what we would like to measure is an output—the impact of our discoveries on human health.

Sharing data creates transparency and illuminates areas that need attention. Tracking and sharing turnaround times for contracting and similar performance metrics for cores, for example, will provide useable information that anecdotes cannot. Data do not elucidate etiology but can direct us to areas that require deeper analyses of root causes. Providing data year-over-year also permits the recognition of trends. At the State of the School I shared information regarding the proportion of women and those traditionally underrepresented in medicine at each rank among ladder track faculty. We will review these data every year so that we can follow our progress.

The faculty portion of our Diversity Strategic Plan now appears on the Office of DEI website and includes the measurement and annual reporting of many metrics. Understanding that 27% of our students belong to underrepresented ethnic or minority groups and that our students often go on to become faculty, the plan focuses on inclusion, mentorship, sponsorship, and proactive retention. The plan emphasizes leading indicators, those in which one can readily assess year-over-year progress, because we believe that improvement in leading indicators will drive improvement in lagging indicators, the ultimate outcomes. The plan does not set annual goals for any of the leading indicators yet, because we must first collect baseline data. We hypothesize that making data visible alone will drive change.

In cases where national benchmarks exist, we must decide to what extent these benchmarks should define our goals. For example, in the clinical arena, benchmarks for metrics of quality and service such as central line-associated blood stream infections (CLABSI), surgical site infections (SSI), or time to third-next available appointment are well-defined, and we should exceed them. In some spheres, such as education, we may lead the development of novel new ways for students to assess themselves. Where national benchmarks suggest that no institution is performing optimally, such as benchmarks for faculty diversity, we will need to create goals that make us stretch. What we choose to measure speaks to our values.

Lastly, data must never be used to shame. If we are to create a culture in which we leverage data to identify and address problems, we must create safe spaces where we can share our challenges and speak honestly about areas where we are underperforming. Such true transparency requires courage. The task should be to remove obstacles, not to place blame. This does not mean that we do not hold ourselves accountable. Rather, we should understand that each of us is responsible for the success of others and for the whole.

“So [we] got that goin' for [us], which is nice.”

Sincerely,

Nancy J. Brown, MD
Jean and David W. Wallace Dean of Medicine
C.N.H. Long Professor of Internal Medicine