Outcome vs. Process

People in healthcare use the term “continuum of care” to describe how various aspects of the system serve the individual patient. The doctor prescribes, the nurse monitors and educates, the therapist rehabilitates, the pharmacist fills, the chaplain counsels and so on and so forth. All these entities, complex in themselves, serve the unified purpose of providing the patient has the best care possible.

Obviously, this doesn’t work nearly as smoothly as a continuum in practical application, but in a country that spends more on health care than any other nation in the world, you can be sure that some steps to address the inefficiencies in care delivery and quality are taking place.

A key paradigm shift has been in the way they measure the quality of care.

To oversimplify, care has traditionally been measured in terms of outcomes, i.e. you check into the hospital with a certain condition, and you come out either better or worse. Your state when you leave is your outcome, and of course, you’re expected to be better when you leave than when you came in. Your outcome was the biggest statement about the quality of care, and it was the standard upon which insurances paid and hospitals made their name.

But the tide seems to be turning to a new sort of measure, here’s why. Outcomes can reveal whether your status has improved or not improved, but not why. So, while we might be able to discern that your outcome of heart failure was bad, we know very little about how we got to that status. It’s like some sort of grade that you got in a drama class or a speech class, you know the kind where the teacher says, “You got a B+” and you wonder where exactly you missed the mark because it seems so arbitrary. Was it because of the doctor or the nurse or the therapist or the pharmacist or the chaplain?

Enter the process measure: Process measures are steps that can be taken to achieve a particular outcome. This means instead of giving you a final grade at the end of the class, you have intermediate steps that serve as gauging your progress. For instance, if you get prescribed a medication, a process measure could be as simple as being educated on how to properly administer the drug and its side effects. Sounds simple, right? But something that simple could ensure a better outcome. Not by itself of course, hence the word process.

What if churches were concerned less with the outcome, and more with the process?

While we have people in church who can answer the question of whether they are saved or not, few of them understand the daily Christian life, or even wrestle with it. In fact, many young Christians I know, wonder what they should do, what they can do, and how to do it. Now, churches often say what you shoudn’t do, but in very few instances, do we shed light or examples on what they can do.

The proper shift can take place from, “Do you know where you will go if you die today?” to “How are you bringing heaven on earth today?”

While on one hand this can sound like a remix of “the journey is the destination” cliche, I think that across the “continuum” of salvation, it would help if the various complex moving parts would see how each contributor to the process — the teacher, the janitor, the engineer, the doctor — would be as valued as the pastor or as the church itself. The outcome is not up to us, but the things in between, the process, is something that seems within our grasp or put more precisely, something that God wants us to take hold of. We can trust God for the outcome.

That is not to say that God is undergoing process (as in process theology), but we are, and that’s a good thing. If we focused less on the outcome, we might increase the quality of care in our churches and our own relationships by focusing on the processes of friendship, vulnerability, and authenticity.

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Comments

  1. danny says:

    have you read “the missional church”? there’s a chapter in there that talked about understanding Christ not as a fixed point, but as a moving target. so then being able to answer the right question doesn’t mean much, because — in the language of the post — the mission of God is always in process.

    so the author brings up two examples. one person, who knows how to answer the “question”, but whose life is steadily moving away from God, and person #2 who does not (or will not) answer the “question” but life is aligned with where God is working in the world. who is saved? hmmm…

    anyway, i have the book if you want to borrow it sometime.

  2. elderj says:

    Sounds like a very intelligent and post-modernistic way of describing things like sanctification and spiritual discipines where the goal is conformity to the image of Christ, but the we measure only what we have control over – are we practicing spiritual disciplines? are we more frequently living in his presence and living his presence out in the world? Questions like this. In some ways this harks back to Catholic spirituality (in terms of spiritual formation, etc.)

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