Ter Braak E W M T
UMC Utrecht, afd. Interne Geneeskunde en Onderwijscentrum, afd. Medische Vervolgopleidingen, Utrecht.
Ned Tijdschr Geneeskd. 2017;161:D1322.
Intuitively, we believe we gain knowledge through taking measurements, and our appetite for quality measurement in general has grown spectacularly. However, this approach has to be qualified. Many aspects of quality are difficult to measure, yet are very important, and choosing what to measure may be heavily influenced by the availability bias of instruments. Moreover, a lot can be known without actually measuring. Quantitative results tend to offer false reassurance simply by their abundance, and results presented by means of Likert scales may obscure the crucial critique of a minority of respondents. Narrative comments in surveys are often much more meaningful as they can foster an open dialogue between residents and their clinical teachers, preferably led by a neutral chairperson. Contrary to what is often claimed, it is even possible to engage in improvement without prior measurement. I propose measuring only in moderation and instead devoting time and money to patient care and educating residents, and on the design and execution of improvement plans.
直观地说，我们认为通过进行测量来获取知识，总体而言，我们对质量测量的需求大幅增长。然而，这种方法必须加以限定。质量的许多方面难以测量，但却非常重要，而且选择测量内容可能会受到测量工具可得性偏差的严重影响。此外，不实际测量也能知晓很多情况。定量结果往往因其数量众多而提供虚假的安心感，通过李克特量表呈现的结果可能会掩盖少数受访者的关键批评。调查中的叙述性评论通常更有意义，因为它们可以促进住院医师与其临床教师之间的开放对话，最好由中立的主持人引导。与通常所宣称的相反，甚至有可能在没有事先测量的情况下进行改进。我建议适度进行测量，而是将时间和金钱投入到患者护理、住院医师教育以及改进计划的设计与实施上。
