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MEASUREMENT PLANSQuality Forum 2012
Melanie Rathgeber
MERGE Consulting
Heidi Johns
BC Patient Safety & Quality Council
Objectives
1.Understand the link between measures for improvement projects and organizational measures
2.Identify potential outcome, process and balancing measures for your work
3.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)
Source: The Improvement Guide
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
Data is used to:
•set priorities
•determine target
•start benchmarking
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
Measures:
•Key Measures•Data over time•Family of measures
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
Measures:
•Key Measures
•Regular data over time
•Tells you how close you are getting to reaching your Aim
What are we trying to accomplish?
How will we know that a change is animprovement?
What changes can we make that will result in improvement?
Act Plan
Study Do
Ideas based on data
e.g.
Do you have a hunch that there is variation in turnaround times?
Does data verify this?
Can you test a way to decrease variation?
Cascade of Measures – from front line to Senior Leaders/Boards
Family of Measures Outcome measures
Based on your Aim statement What are we trying to accomplish? What is ultimately better? Voice of the patient/customer
Process measures
What are you changing – is it really happening? Voice of the system – what is being done differently? Change more quickly than outcomes
Balancing measures
What unintended consequences might occur?
Examples
Outcome
Process
Balancing
Family of Measures in Action – An Improvement Project
- What were the outcome/process/balancing measures?
- How were they chosen?
- How was the data useful in driving improvement?
- What was the data showing us?
Where do I start?• I have a hunch
• I need to determine
a target
• How am I going to get
the information
What actually do I want to
accomplish?
I really needed to develop my AIM• What was I going to DO • by WHEN • by HOW MUCH
• Had a hunch that wait times to receive service were very long
• Had listened to physicians that they were not happy with the process
• How do I tell everyone what we were going to do
Suggestion• Don’t tell,
• Don’t have the idea, let the group you gather come up with the what
• Gather the group, determine who is the right group by asking,
• Who is going to be affected by the change?
Back to the AIM• By September 2011 the completion of referrals from GP’s
and NP’s to the Unit will be 80% by using the correct process and forms.
• I needed to gather the data to see what the completion rate was
• What was the actual wait time to be seen at the Unit
Sidebar conversations• “I don’t think this will be that bad, wait times are not bad”
• “I complete the referrals it gets stalled at their office”
• “ I am not clear on what needs to be done, so we go with what the patient tells us and what we can glean from the referral”
Gathering the data
• Here is what I did………………….
Baseline Data
Baseline Data
Tracking Key Process Measure over Time
Percent of referral forms fully complete
3235
2926 24
80 80
90
0
10
20
30
40
50
60
70
80
90
100
April '11 May June July August Jan '12 Feb April
* Calculations to be confirmed
Starting to Track Time Between Receipt of Referral and Date First Seen
* Calculations to be confirmed
1515
29
1815
30
0
5
10
15
20
25
30
35
40
45
Patient1 Patient2 Patient3 Patient4 Patient5 Patient6
Day
s
Family of Measures in Action – An Improvement Project
- What were the outcome/process/balancing measures?
- How were they chosen?
- How was the data useful in driving improvement?
- What was the data showing us?
Some tips for getting started
“Measurement should be used to speed things up, not to slow them down”
- IHI Breakthrough Series Guide
Some tips for getting started
1. Seek usefulness not perfection
2. Don’t wait for the information system
- IHI Breakthrough Series Guide
1. Seek usefulness not perfection
Key here is to understand the purpose of measures.
2. Don’t wait for the information system.
How “real time data” drives improvement.
Examples?
This can involve new ways of doing things.
New ways of doing things:
stretch yourself to…….
1. find ways of capturing data in a computer-less world.
New ways of doing things:
stretch yourself to…….
2. find ways to embed data collection into work-flow.
Taking data to your audience
Use a balanced set of measures
Display data over time
Essential when taking data to your audience – data over time.
pre-post test, p<.01
*hypothetical data – illustrative purposes only
Spreading change throughout your organization
How does this affect measurement?
Why we are not good at using data: we don’t have a plan of action
What is the plan if data is not at target?• Does it depend on patterns in data?• Does it depend on how much you are off?• What is the “signal” to trigger an action plan?• How was your target set in the first place?
Why we are not good at using data: we don’t have a plan of action
• How do leaders provide support for an area that isn’t meeting a target?
• How is the action plan followed up? What is the accountability? Are people aware of plans and expectations
• What is the plan when data does meet target?
Data Display Principles
Starting to Track Time Between Receipt of Referral and Date First Seen
* Calculations to be confirmed
1515
29
1815
30
0
5
10
15
20
25
30
35
40
45
Patient1 Patient2 Patient3 Patient4 Patient5 Patient6
Day
s
Percent of Patients w ith Appropriate VTE Prophylaxis
0
20
40
60
80
100
Oct NovDec
Jan
Feb
Mar
chApr
il
May
June Ju
ly
Augus
tSep
t
MTU
4 East
Shuswap
*hypothetical data – illustrative purposes only
“SMALL MULTIPLES” – all info on one page
0
10
20
30
40
1/1/09
2/1/09
3/1/09
4/1/09
5/1/09
6/1/09
7/1/09
8/1/09
9/1/09
10/1/
09
11/1/
09
12/1/
09
1/1/10
2/1/10
ProvincialReadmission Rate
0
10
20
30
40Large Teaching
Hospitals
010203040
Large Community Hospitals
010203040
Medium Community Hospitals
010203040 Small Community
Hospitals
*hypothetical data – illustrative purposes only
Resources:
BCPSQC Measurement Report http://www.bcpsqc.ca/pdf/MeasurementStrategies.pdf
Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP (2009) The Improvement Guide (2nd ed).
Provost L, Murray S (2011) The Health Care Data Guide.
Back to Objectives
1.Understand the link between measures for improvement projects and organizational measures
2.Identify potential outcome, process and balancing measures for your work
3.Discuss the importance of using data to drive improvement (and why we are typically not very good at it)
