Editor’s Desk

Trust the Process (Measures)

Peter Wehrwein

When Joel Embiid, the Philadelphia 76ers center, shoots free throws, the home crowd chants, “Trust the process, trust the process.”

The fans are being sarcastic. For the last few years, the team’s leadership has purposely put together absolutely miserable teams. The idea was to guarantee losing records, so the team would, year after year, have high draft picks and, eventually, a roster full of young, talented players like Embiid. The former general manager, Sam Hinkie, preached patience and asked the fans to trust the process.

But as of this writing, the team is 7-21 this season and dead last in its division.

Measurement of health care quality also requires trusting the process, as in process measures (they also go by the name performance measures).

Process measures are roundly criticized. Fundamentally, you are gauging the means to the end when it is the end—keeping people healthy or returning them to health after an illness or injury—that is the purpose of health care. Process measures may also encourage a check-the-box mentality. Measuring how many patients who smoke received smoking cessation advice does not distinguish between the perfunctory admonition and a serious effort to get the person to quit.

But we really don’t have much choice but to trust process measures. The factors that affect outcomes are too varied and outside the clinician’s control. Process measures are more easily measured and relate directly to a clinician’s actions.

The trick is to do the research and identify the processes that most reliably lead to good outcomes—and to ditch the rest.