Dr. Lawrence WeedAmerican architect Louis Sullivan, who coined the iconic phrase “form ever follows function,” was flat wrong – at least when it comes to the relationship of what we do and how we capture it with data.  The reality is instead that the medium shapes the message, and that record-keeping alters the processes it records.  Need a current example?  One only has to consider how the President’s staccato bursts of tweets now drive public attention, media focus, and policy debates, both domestically and abroad.

But a more profound example is the life’s work of Dr. Lawrence Weed, who passed away last week at age 93.  In the 1950’s while a professor of medicine and pharmacology at Yale, Dr. Weed began a lifelong crusade to elevate medical practice by changing how patient records were kept. At that time, it was commonplace for medical records simply to compile information about the patient, organizing it by source – lab data, test results, x-ray reports, progress notes, pre- and post-operative reports, and discharge orders.  Such “source-oriented” information failed to state plainly the patient’s problems, the plan to address each problem, the care delivered per problem, and the observed results.  According to Dr. Weed:

When people source-orient data, you appear very unscientific.  But it’s even worse than the appearance.  It’s the very essence of the practice of medicine. This is not an idle discussion of little, technical, bookkeeping details.  The practice of medicine is the way you handle data and think with it.  And the way you handle it determines the way you think.  Once you get, over a period of time with multiple variables … the very structure of the data determines the quality of the output.  And this is what’s so hard for Medicine to accept.  They can’t say things like “I know lots of doctors who don’t keep good records.”  They can’t be separated that way.

Dr. Weed’s key insight was that better-organized, more complete, and more consistent medical records would actually change how healthcare professionals practice medicine.  A different, required format for medical records would drive what doctors and nurses do, how they make decisions, and how they deliver care to patients.  His concern was not bookkeeping as an end in itself, but as a means to quality care:

And mind you, if you can’t audit a thing for quality, it means you do not have the means by which to produce quality.  They’re inextricably entwined ….  If you can’t evaluate what you’re doing, then there’s a very serious possibility that you do not know what you’re doing, and that you’ve never defined your goal.  And that’s true in Medicine – we have not.

His solution? The problem-oriented medical record (“POMR”), a better approach to recording patient information. Two elements of POMR remain with us today, in medical practice world-wide: first, the compiling of problem lists for patients, and second,  the SOAP system (subjective, objective, assessment, and plan) for capturing information in a patient’s chart.  Dr. Weed went on to other accomplishments, such as harnessing computer power for diagnoses.

The lesson is clear, as straightforward as a patient chart that would’ve passed muster with Dr. Weed.  Records do more than merely memorialize what we did and what then happened.  An organization’s choices about what to document, how to document it, and in what format will have an inexorable impact on what gets done at the organization and how well it will get done. In this sense, records are a measurement tool for your business operations, and you can only manage what you measure.

So, regardless of your industry, the next time you want to improve operations at your organization – or simply want to improve performance under existing processes – take a hard look at your record-keeping.  Your approach to records could be your problem … and ultimately, could also be your solution.