Measurement for improvement

Musa Abu Sbeih Nursing Affairs Department

Al-Massarra Hospital

Question?

How do we know a change is an

improvement?

Definition

Measurement: The systematic collection of quantifiable data about both processes and

outcomes overtime or at single point in time.

Measurements 

The Purpose of collecting data is not to put everything into neat figures, but to provide a basis for action.

“ K. Ishikawa ”

What gets measured gets done

” Tom Peters “

Establishing Your Baseline

Why Measure?

To:

• Identify ways to improve

• Because Change

• Track performance improvements

• Focus efforts on “right things”

• Communicate strategies and direction

• Recognize/ reward

Not to:

• Threaten

• Inhibit change

• Reduce risk-taking

• Make comparisons between like units/Wards

• Protect one’s backside

Measure the “right things”Traditional Measurements

• Focus on costs and control

• Top-down driven (non-participative)

Desired Measurements• Effectiveness

– Doing the right things

– Quit doing wrong things

• Efficiency

• Support strategic initiatives

• Simple

• Involve employees in the development

The Improvement Guide, API

Model for Improvement

Using Data to understand progress toward the team’s aim

Using Data to answer the questions posed in the plan for each PDSA cycle

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What do we Measure?

Is Productivity different from Performance؟

Formats of Measures

Quiz

• Care Experience

• Staff Engagement and Potential

• Healthcare Associated Infection

• Emergency Admission Rate/Bed Days

• Adverse Events

• Hospital Standardized Mortality Rate

• Under 75 mortality rate

• Patient Reported Outcome Measures (PROMs)

• Self-assessed general health

• Percentage of time in the last 6 months of life spent at home or in a community setting

Quiz: Which are measures?

• Care Experience

• Staff Engagement and Potential

• Healthcare Associated Infection

• Emergency Admission Rate/Bed Days

• Adverse Events

• Hospital Standardized Mortality Rate

• Under 75 mortality rate

• Patient Reported Outcome Measures (PROMs)

• Self-assessed general health

• Percentage of time in the last 6 months of life spent at home or in a community setting

Quiz: Which are measures?

System Components

Process Outcomes

Structure

Donabedian, A. Evaluating the Quality of Medical Care. Milbank Memorial Fund Quarterly 44:166–203, 1966

O = S + P

Types of Measures

Examples

Potential Set of Measures for Improvement in Male wards

Balancing Measures

Process Measures

Outcome Measures

Topic

Volumes

%LAMA

Staff Satisfaction

Financials

Flow of Patient in each ward

Patient/staff comments on flow

%patient receiving discharge plan

Availability of Medication

Total LOS in each ward

Patient Satisfaction Survey

Improve ALOS and Patient Satisfaction

Key Measures: Female Wards

Outcome Measures 1. Restraints rate

2. Readmissions within 28 days after discharge.

3.Falls rate

4. Patient Injuries ratio

5. Percent of patient with MNS

Process Measures6. Average length of stay (ALOS)

7.Number of calls to the crisis intervention team

8. Percent compliance with break away techniques

9. Percent compliance with hand hygiene

10. Percent achievement of multi-disciplinary rounds and daily goals

11.Percent compliance with using safety briefings

12.Percent compliance with using SBAR

Balancing Measure13. Staff satisfaction in Female acute

Cause and effect diagram

Social issues

Staff attitudes Complications

Procedure Patient perception Post discharge support

Prolonged LOS

Atypical Drugs

Diagnosis

nutrition

Treatment Protocol

LOSTeam work

communication Cost mind

expect long LOS

home supportoften weak

poor understanding of procedure

little knowledge of support services

family support

poor prognosis

Disease complications

Side effects

community health

general practitioner

family

Community care nurse

Building a Cascading System of Measures

Hospital Board Level

Service Lines

Care Givers, Patients & Families

Units, Wards & Departments

Macro Level Metrics

Micro Metrics

Macro Level

Meso Level

Micro Level

Health System Levels:IOM Chasm Report Chain of Effect

Health System

Clinical Service Line

Clinical Unit

Care Giver

Patient

Information System Design Principle: Capture data at lowest level and aggregate up to higher levels for cascading metrics throughout system.

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Mesosystem

Macrosystem

Microsystem

Nursing Services

Nursing Divisions

FrontlineNursingUnits

Example

Source: Hendriks & Bojestig, Jonkoping CC Sweden

System Levels

Application Exercise

(10 minutes)

Where are we now?

Give an example of a quality improvement activity/project that you

have been involved with during the past year or are currently. Describe its

development, goal, implementation, evaluation of success.

References1. Byers, J.F., & Beaudin, C.L. (2001). Critical appraisal tools facilitate the

work of the quality professional. Journal for Healthcare Quality, 23(5), 35–38, 40–43.

2. Byers, J.F., & Beaudin, C.L. (2002). The relationship between continuous quality improvement and research. Journal for Healthcare Quality, 24(1), 4–8.

3. Kelly, D. (2003). Applying quality management in healthcare: A process for improvement. Chicago: Health Administration Press.

4. Kotter, J.P. (1996). Leading change. Boston: Harvard Business School Press.

5. Merriam-Webster’s collegiate dictionary (10th ed.). (1994). Springfi eld, MA: Merriam-Webster.

6. National Association for Healthcare Quality (NAHQ). (2004). NAHQ Code of ethics and standards of practice for healthcare quality professionals. Glenview, IL: Author. Retrieved April 5, 2005, from www.nahq.org/about/code.htm