Denial Ain’t Just a River in Egypt: 5 Stages of Reactions to Quality Report Cards

We received the our monthly physician quality report cards recently.  Software mines our EHR and generates these reports to tells us if we are meeting our quality goals.  These goals are defined by recognized guidelines or insurance companies pay for performance programs.  As usual, a great hue and cry arose from the audience.

I prefer creating and using our own data instead of relying on incomplete and inaccurate claims data from insurance companies.  While I firmly believe that we must measure our performance then use the data to improve our clinic operations,  I have been through this often enough to find our reactions humorously consistent.  Dr. Kubler-Ross could use us as a case study.

  1. Denial – “These patients aren’t mine.  The attribution algorithm is wrong.”
  2. Anger – “I referred him 5 times to get a colonoscopy”
  3. Bargaining – “If they could just correctly identify my patients, then I would know where to start.”
  4. Depression – “This is impossible.  How can I get my patients to exercise?  I’ve told them a thousand times.”
  5. Acceptance – “OK, fine.  Schedule those diabetics to see me with our dietitian so we can talk about healthy eating.”

After a few meeting we work through Stage 5 and get back to work.

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