By Susan Pohl, MD
Like most students studying algebra for the first time, I remember having the distinct feeling that the subject was strange and disconnected from the other subjects. It appeared to be impractical and esoteric. However, I distinctly remember my math teacher that introduced me to algebra. She was a middle aged woman (like me, now!) who wore very comfortable shoes. Her dark pants always seemed to collect chalk dust in awkward patterns, and she had an abundant amount of energy when discussing this seemingly mundane subject. One day, she announced that understanding algebra would give us power by declaring, “If you understand math, you can do anything”. I think several students snickered, and I am not sure that many were convinced. I thought, however, this idea sounded intriguing
As I studied microbiology, pharmacology, public health and engineering, these words which equated math and power were somehow revealed to be true. Mathematical formulas can describe the growth of bacteria and the power of anticoagulants. The forces of physics can be used to predict the movement of oxygen into the lungs of a newborn and the forces at work within a ventilator. Understanding such mathematical principles can give physicians some control in improving people’s lives for the better. I have found that fighting disease processes and impacting lives frequently have roots in understanding mathematics. This once-believed esoteric subject had power to change lives.
Healthcare systems now collect numerous quality metrics. These graphs and ratios can seem distant from the “real work” of medicine. These mathematical systems seem just as strange and esoteric as my first introduction to algebra. They don’t seem to have power. Do these graphs really impact people’s lives? And yet, such graphs and charts actually can be some of the most powerful tools that we use to refine the way we deliver care for our patients. We can imagine better care, and we can create systems that provide that care to our communities using the tool of mathematics.
Implementing evidence-based protocols for pneumonia and monitoring their use has been shown to improve patient survival while decreasing complications and costs. Implementing immunization protocols and monitoring at-risk populations can decrease disease burden. Standard work for managing postpartum hemorrhage saves maternal lives. These graphs have power. Implementing the best care every time we see a patient means that more patients are discharged home from the hospital after pneumonia, fewer patients need care in the hospital for vaccine-preventable illness, and fewer mothers die of common complications such as post-partum hemorrhage. Graphs and charts, as models of mathematics, have power. They impact real lives.
As I teach Quality Improvement to a new generation of residents, I find myself in a similar situation as my former algebra teacher. I am standing in my comfortable shoes trying to contain my energy for the work we do. My quizzical residents don’t always understand the power behind the work they do. My job is to share my conviction that understanding data, employing system thinking and leading teams to improve quality data can be one of the most powerful, rewarding and energizing parts of healthcare. I don’t have chalk on my pants, but I do share the energy for this work. I look forward to seeing what impact our residents can have when they leave our practice. My hope is that they continue to see healthcare data as an opportunity to impact lives.
Susan Pohl, MD is an assistant professor with the University of Utah Division of Family Medicine