Measurement in Greater Detail

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Presentation transcript:

Measurement in Greater Detail

What are we trying to accomplish? Idea of cascading measures Revisiting our team level dashboards Measurement for PDSA cycles

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 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

Phases of improvement Development - Small scale PDSA level Testing under multiple conditions Implementation Spread Could we illustrate relevant measures for a process of interest at every level?

(CLAB Insertion Bundle) Example 1 (CLAB Insertion Bundle) Example 2 Example 3 Development Acceptance of drape Availability of pre-pack Compliance to individual elements or orprocess steps (hat use) Testing Compliance to the bundle (focus on change) undering varying conditions CLAB rate on the ward Implementation Compliance to the bundle (focus on monitoring) Cost of pre-packs per month Infection Rate (small multiples by ward and aggregate at facility)

Break out 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 two 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

(CLAB Insertion Bundle) Example 1 (CLAB Insertion Bundle) Example 2 Example 3 Development Acceptance of drape Availability of pre-pack Compliance to individual elements or process steps (hat use) Testing Compliance to the bundle (focus on change) under varying conditions CLAB rate on the ward Implementation Compliance to the bundle (focus on monitoring) Cost of pre-packs per month Infection Rate (small multiples by ward and aggregate at facility)

Creating dynamic insight into improvement Outcome Measure(s) Process Measures Getting Movement Here, Get Movement Here by Get movement here by Balance Measure(s) Process Step Measures Hold these constant or improve them Getting movement here

Break out 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? How would you display the information collected for your team? Consider my friend from Ekombe Hospital Where would you display your data so it is accessible to your team and other stakeholders on a regular basis?

Creating dynamic insight into improvement Outcome Measure(s) Process Measures Balance Measure(s) Process Step Measures

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.