IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v253y2020ics027795362030201x.html
   My bibliography  Save this article

Failing the metric but saving lives: The protocolization of sepsis treatment through quality measurement

Author

Listed:
  • Winslow, Rosalie

Abstract

Quality metrics in the healthcare sector have become a key component of ensuring improved health outcomes and care equity. Alongside the emergence of information technology in healthcare (eg. electronic health records), the primary method utilized to infer “quality” has been the development of measures for healthcare processes and outcomes. Engaging with the specific case of sepsis treatment and sepsis quality metrics, this paper traces how quality is defined, measured, and codified in a 600-bed acute-care hospital in New York City. Sepsis is a severe health condition, primarily managed in the emergency department, that is caused by infection and can result in multi-organ shutdown and mortality. Multiple government agencies have established metrics that regulate New York hospitals based on their compliance with specific sepsis treatment procedures. I draw on data from a 15-month ethnography and in-depth interviews with clinicians and administrators, to show how quality measurement is reshaping the ways healthcare is delivered and organized. I reveal how, at Borough Hospital, efforts to treat sepsis based on quality metrics have constrained clinician expertise, prioritized compliance, and reoriented workflow towards standardized treatment protocols. This reorientation leads to, what I term abstracted surveillance protocols, that increasingly regulate definitions of healthcare quality. I demonstrate that abstracted surveillance protocols enable highly complex clinical processes to be measured based on metric compliance rather than clinical pathways, therefore moving definitions of quality away from the bedside.

Suggested Citation

  • Winslow, Rosalie, 2020. "Failing the metric but saving lives: The protocolization of sepsis treatment through quality measurement," Social Science & Medicine, Elsevier, vol. 253(C).
  • Handle: RePEc:eee:socmed:v:253:y:2020:i:c:s027795362030201x
    DOI: 10.1016/j.socscimed.2020.112982
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795362030201X
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2020.112982?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Barry G Saver & Stephen A Martin & Ronald N Adler & Lucy M Candib & Konstantinos E Deligiannidis & Jeremy Golding & Daniel J Mullin & Michele Roberts & Stefan Topolski, 2015. "Care that Matters: Quality Measurement and Health Care," PLOS Medicine, Public Library of Science, vol. 12(11), pages 1-10, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dean D Akinleye & Louise-Anne McNutt & Victoria Lazariu & Colleen C McLaughlin, 2019. "Correlation between hospital finances and quality and safety of patient care," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-19, August.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:253:y:2020:i:c:s027795362030201x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.