A quote from Robert Persig in some e-magazine recently sent me back to “Zen and the Art of Motorcycle Maintenance,” a 1974 novel that college pseudo-intellectuals like me carried around Villanova as a badge of coolness.

It didn’t work.

Today, its’ message is still beyond my grasp but my approach to management in health care is definitely shaped by what I think Pirsig was trying to impart. The subtext of the novel is his effort to define “quality” (I think and so critics say).

At the Fields, the variability and chaotic nature of geriatrics and dementia, by themselves and especially taken together, make the effort to define quality and then provide quality…of care, of meals, of amenities, of companionship day in and day out, a great challenge.

There is no objective measure of any of these “qualities” and our guests have never been old before and didn’t plan on getting dementia and other aging syndromes, so they don’t know what to expect.

So, how do we know how we’re doing?

If our guests and their families are “happy” or “satisfied” with our care, then I guess that’s one measure.

If quality is measured by the absence of problems or by the total of some positive features, or both, then that’s another, or two more, measures of quality.

In geriatrics, I’m starting from a hard place because my new guests are often coming from hospitals and skilled rehabilitation facilities, working through one or several medical or psychiatric problems and there’s no common starting point or pathway.

If we were all going out to dinner or a Red Sox game, we could pretty easily agree on “quality” indicators. The food was great, the service was good, the Sox won, the seats were excellent, the beer was cold and the hot dogs hot… you follow?

Not so at Bellamy and Watson. American medicine is running out of cures as aging in general outpaces allopathic remedies. Some health providers and health products define quality as doing something better than their peers- a high rate of successful procedures, a low rate of complications, a more effective medication or treatment by statistical significance…assisted living and long term care don’t collect data like this (or if they do, they don’t share).

Pirsig never gets around to defining quality but I think he’d credit me for simply asking “what is it” and plodding along.

It’s not the end, it’s the means to it.