Steven Lewis's blog

Baseball Forbids Pay for Performance – A Lesson for Healthcare?

Submitted by Steven Lewis on May 10, 2012 - 15:21

Baseball has terrific and comprehensive performance data to which it pays assiduous attention, and an outcomes-based culture. Yet its collective agreement forbids pay-for-performance (P4P) based on players' reaching certain statistical performance targets, like number of home runs or stolen bases. Health care ignores far more data than it pays attention to, yet P4P has been touted in many organizations as the solution to problems of quality and efficiency. This despite the dearth of comprehensive, valid data that relate what a provider does to how well her patients do. This post explains what baseball understands about P4P and why what seems to be a good idea in theory is fraught with unintended consequences in practice.

Do Clinicians Need Spring Training?

Submitted by Steven Lewis on December 6, 2011 - 18:29

Baseball has spring training and no one is exempt from the drills, the repetitions, the fine tuning, the repetition. It is not just a rite of spring; it is fundamental to the pursuit of excellence. Baseball assumes that skills are impermanent, mastery is fleeting, coaching is essential, and practice never ends. Health care assumes that skills once achieved are permanent, mastery comes with time, coaching is unnecessary, and practice is for students. Baseball has it right.

What Joe Paterno Could Have Learned About Disclosure from Health Care

Submitted by Steven Lewis on November 11, 2011 - 13:44

Penn State University is aflame, its President, two senior officials, and sainted football coach Joe Paterno out the door after 46 years. A former assistant coach, Jerry Sandusky, is under indictment for multiple sexual assaults against young boys over a 15 year period. Health care used to be renowned for its insular culture of secrecy and inability to do right by its victims. It has come a long way. I would like to think that health care CEOs would have responded more honourably and more swiftly than Paterno to a similar crisis.

What Health Care Can Learn from Skating

Submitted by Steven Lewis on November 8, 2011 - 12:07

When performance measurement fails, bad things happen. Figure skating learned that lesson the hard way. Its performance measurement system has evolved from an arbitrary and often corrupt gong show to an increasingly reliable (though still imperfect) science. That it has made progress despite its rigid and hidebound culture is all the more reason for health care to learn from its travails.

How to contribute to the MASH blog

Submitted by Steven Lewis on November 1, 2011 - 13:27

The MASH blog is intended as an open forum that welcomes contributions from anyone interested in making meaningful analogies in sports and health. We will shortly be set up for you to submit content directly to the moderator through the Open Medicine site navigation tools. But for now, contributors should submit their content via e-mail to:

Coming to Terms with Performance Data: My Hero, Duke Snider, Was Not As Good As Mickey Mantle and Willie Mays

Submitted by Steven Lewis on October 18, 2011 - 06:45

Emotional attachments often lead people to overstate the ability and performance of people close to them. Duke Snider, the great Brooklyn Dodger center fielder, was my first sports hero. I thought he was the greatest. He was excellent, but he was only the third best center fielder in New York, after Mantle and Mays (or Mays and Mantle). Coming to grips with the incontrovertible statistical evidence on the relative performance of one's heroes is part of growing up. It's the same in health care: viewing performance through rose-tinted glasses can be harmful to one's health.