A Unique Way to Get Others to Improve

Joe’s haircut is darn ugly. What are effective ways to persuade Joe, or other people and organizations, such as healthcare providers, to make improvements? One way is to issue orders, but that only works if you’re the boss. Another way is to reliably predict a bad outcome unless improvements are made, as in the case of budgets, health, safety, etc. Yet another way is to teach how to improve on a specific key measure, which can work if people or organizations are self-driven.


It’s often pointed out (e.g., in this Harvard Business Review article) that people are motivated by peer comparisons, which are effective because it’s human nature to notice others and be influenced by them, and because the comparisons are easy to grasp: Your Peer does better at X, and X is important, so try to measure up! But a comparison to a single Peer is subject to the defensive reaction that the Peer has very different circumstances, so the two aren’t comparable!

I wish to put forth a way to make peer comparisons that are arguably persuasive, but rare. People seldom think of them and they are hard to come up with without the help of automated comparisons of available data. These peer comparisons are characterized by a second measure, Y.

Consider telling Joe this comparison:  You have the ugliest haircut of everybody as good-looking as you! Notice that you are implicitly using two measures: (1) haircut ugliness, and (2) good looks. The peer group is everybody who is at least as handsome as Joe. Within this elite group, unfortunately Joe does the worst. On the one hand, Joe feels good about his comparison group, and on the other hand, he has the worst outcome, assuming he cares at all. And the peer group is large, unless Joe is stunning!

Now, for you logician readers, let’s acknowledge that “Joe has the ugliest haircut of everybody who is as good looking as him.” is absolutely equivalent to “Joe is the best looking of everybody with such an ugly haircut.” But psychologist readers will agree that the first version does better at motivating performance improvement, since a likely human reaction to the second version is “Well, at least I’ve got something going for me!

It turns out that automated experiments with healthcare or business data turn up a large number of such peer comparisons. Here are three actual, but anonymized, insights taken from various healthcare sectors at BenchMine.com:

1.    A California hospital has the lowest communication-about-medicines rating (2 stars) of the 358 hospitals with as high an overall patient rating (5 stars). Those 2 stars compare to an average of 4.3 stars across the 358 hospitals.

2.    In the Southwest, a Texas home health agency has the fewest patients who got better at getting in and out of bed (19.1%) among the 1,651 home health agencies with at least 49.1% of patients who got better at walking or moving around. That 19.1% compares to an average of 65.3% across those 1,651 home health agencies.

3.    Pennsylvania nursing home has the most short-stay residents who had an outpatient emergency department visit (34.1%) among the 317 nursing homes with at most 10.1% of short-stay residents who were rehospitalized after a nursing home admission. That 34.1% compares to an average of 9.8% across those 317 nursing homes.

The basic “shaming” message is this: Why are you so bad at X if you’re so good at the related measure Y? Everybody else with such a good Y is doing better than you! Of course, the world is filled with such potential insights, although coming up with verifiable ones may best be done with rigor by software, as long as data can be collected and analyzed.

Instead of merely ordering Joe to get a new barber, presenting him with a book on hairstyling, or predicting that his love life is doomed unless he improves, let’s try pointing out how poorly he stands out as compared to his wonderful peer group! The same goes for Doris the hospital’s chief quality officer, Nancy the home health agency’s chief nurse, and Mary the nursing home’s director.

[First published on LinkedIn Pulse]

Raul Valdes-Perez


Standout Scores: Express the Comparative Performance of a Nursing Home with a Single Score, Based on Reported Insights

OnlyBoth has launched a new benchmarking-engine capability which objectively scores how each nursing home across the country stands out from others, both positively and negatively. The resulting standout score is a count of how well a nursing home stands out compared to various peer groups, as seen in the engine’s reported insights for that nursing home. Although not designed as a comprehensive ranking, the scores express comparative performance over a broad range of criteria.


According to the OnlyBoth standout scores for nursing homes, the top 5 U.S. nursing homes out of more than 15,000 in the country are these:

  • #1 University Post-Acute Rehab in Sacramento, CA
  • #1 Kaiser Foundation Hospital Manteca Distinct Part Skilled Nursing Facility in Manteca, CA
  • #3 Signature HealthCARE At Sts. Mary & Elizabeth Hospital in Louisville, KY
  • #4 Brian Center Health & Retirement/Cabarrus in Concord, NC
  • #4 Manorcare Health Services-Green Tree in Pittsburgh, PA

The scores have several uses. First, let’s say that you’re preparing a candidate list of good-performing nursing homes for a prospective resident. To score all the nursing homes in a county, click on the Score nursing homes button and enter its name in the county search box.

Second, while you’re evaluating the detailed performance of a nursing home, click on the left-side question: Where does it stand in its county? in order to highlight its ranking within all those peers.

Third, to score all the homes within a peer group you select, say for investigative or marketing purposes, e.g., all government-owned nursing homes, click on Query across nursing homes and formulate your own query.

To see what underlies the top standout scores, check out some key reported insights on California’s University Post-Acute Rehab in Sacramento and Kaiser Foundation Hospital in Manteca.

University Post-Acute Rehab is the only one of 36 nursing homes in Sacramento County which has a 5-star rating in each of overall, health inspection, quality measures, and registered-nurse staffing. The facility also has the lowest total number of health deficiencies (zero) of the 36 nursing homes in the county.

Kaiser Foundation Hospital is only one of two nursing homes in all of San Joaquin County that doesn’t have any facility-reported incidents, substantiated complaints, fines, or payment denials. It also has the lowest total number of health deficiencies (zero) of the 26 nursing homes in the county.

It’s very illuminating also to check out what underlies the worst standout scores, nationally or just in your own county.

The scores are completely transparent, just like healthcare is becoming with the help of automated benchmarking engines. You can calculate a nursing home’s score yourself, in seconds, by going through its reported insights and subtracting the negative ones from the positive ones, as explained here at the bottom.

Our standard scores are similar in spirit to Nursing Home Compare’s overall rating, which is very complex. There is a substantial correlation (0.58) between standout scores and overall ratings. Standout scores are completely linked to a nursing home’s public, comparative performance along all the included data dimensions, and is completely automated regardless of new data attributes that may be added, e.g., on patient surveys, pricing, or consumer reviews.

By empowering new uses, such as consumers wanting to create a list of candidate nursing homes to visit or to evaluate more deeply, standout scores contribute to healthcare transparency and thus ultimately to the goal of driving performance improvement.

Why Comparing Healthcare Providers Needs Automation

I’ve lived for years in the same area of Pittsburgh, whose streets don’t follow a grid design since it’s hilly and pre-dates the automobile. Sometimes before driving to a familiar destination, I’ll check Google Maps, which alerts me to a favored route that I didn’t even know existed. I act on the suggestion which usually turns out great. Is this unique to mapping, or can this happen in other domains of reasoning and discovery? How about healthcare?

Solution Spaces and Artificial Intelligence

Automated mapping helps me discover new routes not because I’m spatially challenged, but because the software explores side streets which motorists like me don’t consider. Instead, motorists tend to consider the larger, familiar streets that head toward their destination. Using Artificial Intelligence (AI) concepts, we say that mapping software searches for solutions within a larger space of possibilities than people do. In chess play, software considers piece sacrifices which none but top players will ever think of. It also occurs in scientific research. This should happen in healthcare, too, where there are huge potential gains for many stakeholders and rich data sets are publicly reported.

[Continue reading at LinkedIn Pulse …]