Measuring Quality Improvement Brandon Bennett

What are we trying to accomplish? Distinguishing types of variation, performance and the use of targets Idea of cascading measures Revisiting our team level dashboards Measurement for PDSA cycles

Two considerations on using data What is the process/system currently doing? Two more considerations: Common Causes Special Causes What performance would we like? Targets Specifications Aims imposed, hoped for, improved towards Inspected out Compare here Remove/return to common cause Institute improvement to achieve Once here, intend special cause variation through change to move toward the specification of interest

But Why? Two Dangers for Leadership Tampering – intervening/taking action on the process/system when performance is statistically stable – wastes resources and can make things worse Failing to Intervene – when the process/system is indicating a need for correction/improvement, this failure can waste resources through poor management and/or lead to a more expensive fix further in the future

O1 P1 O2 P2 B S3 S2 S1 System of Feedback Measure Types O = Outcome Measure P = Process Measure B = Balance Measure S = Process Step Measure PDSA = Learning Cycle Measure O2 P2 B S3 S2 S1 System of Feedback PDSA1 PDSA2 PDSA3 PDSA4 © Improvement Science Consulting

O – Patient Satisfaction B O - Mortality P - ALOS Measure Types O = Outcome Measure P = Process Measure B = Balance Measure S = Process Step Measure PDSA = Learning Cycle Measure O – Patient Satisfaction B P1 P2 S – Time to Theatre S2 S1 System of Feedback (Hip Fracture) PDSA1 PDSA2 PDSA3 PDSA4 S3 © Improvement Science Consulting

Break Out Exercise Review your team level dashboard Are you aimed too high? With too much emphasis on the outcome or process measures of interest? If so, what are the steps in your process (Process Map) What Process Step Measures could be developed to help you understand performance closer to the frontline of care? Do you collect that information currently? How could you collect and use that information at the frontline? i.e. CAM tool used reliably on all patients (CAM tooled used/All Admissions to ward 4 reported daily/weekly on a run/control chart)

As the scale of the test increases we move from qualitative to quantitative evidence Very small scale test of a change idea Large scale test of change idea or Implementation of a change idea Evidence primarily Qualitative Evidence primarily Quantitative with noticeable impact on process measures Sequence of learning and change © Improvement Science Consulting

Break Out Exercise Revisit one Change Idea you have for improving care in your process area See if you can develop measures that will help you learn about the Change Idea’s operational efficacy (increase degree of belief) starting with a test of change focused at the smallest PDSA level (i.e. 1 patient, 1 nurse, 1 day) and moving through 2 or three steps to the Process Step Measure Level Note: The learning questions and individual PDSA measures should evolve with each cycle, if nothing else than to reflect the increased scale of the cycle

Break Out Exercise Revisit the Process Step Measures you identified earlier How would your team collect the information identified? What would a data collection tool look like for these measures? Where and how would you display the information collected for your team?

Model for Improvement Act Plan Study Do What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement Act Plan Study Do Langley, et al.