1. Healthcare Performance Measurement
Quality & Accreditation Directorate
*Quality is every body business
*One of Q&AD big goals is to Improve the quality of healthcare services, (do no harm to patients)
Q&AD Role:
Provide technical support through training & guidance on how to achieve quality healthcare service & Maintaining continuous Q improvement, e.g.:
Strategic & action plans
Policies & procedures
Problem solving
How to measure performance (indicators, auditing)
Accreditation (which is a tool for measuring quality)
Other Skills that assure & help in implementing & maintaining high quality of healthcare services
One of the tools used is indicators ( performance measures)
To develop an indicator which is scientifically sound certain steps should be followed:
* training
* formulate a team
* review literature
* adopt or develop indicator
* do necessary modifications (what should be included /excluded from N/ D Define terms..... Data elements From where data should be extracted How frequent) -----> information set
* develop data collection form if needed
* pilot
* modify
* apply
Q&AD because it's a new concept did the training, shared in developing IS &DC forms, collects data, analyses it , produce reports for hospital to
*Review it
*Investigate why & identify weaknesses in the process or system
*Recommend & Implement corrective actions
*Follow up next report to monitor if such corrective actions where effective or NOT
What is an indicator
It's a number reflecting a rate ( N/D) for you to ask yourselves
*How far am I from the standard figure
*Or am I satisfied with the number
* can I improve it by improving our performance
* how can we improve our performance
Feedback to Q&AD and it's importance
eg of indicators report from life: Bill from MoE
Shows fig of how much is your electricity consumption in relation to cost
What would be your reaction if it is high?
Investigate is it due to error in reading
Or it's actual
What next if actual?
You would take serious actions in cutting off unnecessary consumption which reflect on reducing cost.!!
Next MoE Bills are your way to find out if actions are effective & whether maintained or not
This example is compatible with Q&AD reporting of indicators
As the directorate gathers the data & provide you with the figures For you to act upon them as you know more about your practices & hospital.

2. Introduction
Definitions
Understanding Quality Indicators
Exercise

3. Quality Accessibility Client-Centered Safety Work-life
Continuity of Service
Competence
Population Focus
Effectiveness
Efficiency
Accessibility: Providing available, timely and equitable services.
Client-Centered: Putting clients and families first.
Safety: Keeping people safe and preventing harm to the users, providers and environment
Work-life: Supporting wellness in the work environment and promoting work-life balance
Continuity of Service: Experiencing coordinated and seamless services over time
Competence: Knowledge, skills and actions of individuals providing service are appropriate to the services provided
Population Focus: Working with the communities to anticipate and meet needs
Effectiveness: Doing the right thing to achieve best possible results.
Efficiency: Making the best use of resources.

4. Measurement
Measurement.. is the assignment of numbers to objects or events.
Managing quality requires measuring it.
By monitoring specific objects or events, we are able to measure defined variables
They may either directly measure or indirectly reflect the quality of care provided.
Hence, they are referred to as Quality Indicators
Indicators are customised according to the local context and circumstances.
Explain the concept of the indicator threshold (e.g. thermometer, Speed meter)
What is an indicator
It's a number reflecting a rate ( N/D) for you to ask yourselves
*How far am I from the standard figure
*Or am I satisfied with the number
* can I improve it by improving our performance
* how can we improve our performance
Feedback to Q&AD and it's importance
eg of indicators report from life: Bill from MoE
Shows fig of how much is your electricity consumption in relation to cost
What would be your reaction if it is high?
Investigate is it due to error in reading
Or it's actual
What next if actual?
You would take serious actions in cutting off unnecessary consumption which reflect on reducing cost.!!
Next MoE Bills are your way to find out if actions are effective & whether maintained or not
This example is compatible with Q&AD reporting of indicators
As the directorate gathers the data & provide you with the figures For you to act upon them as you know more about your practices & hospital.

5. Indicators
They are measurable and defined variables that refer to the structures, processes, or outcomes of care.
Indicators indicate good quality of care or potential problems
They are developed using review criteria and standards
Indicators are customised according to the local context and circumstances.
Explain the concept of the indicator threshold (e.g. thermometer, Speed meter)
What is an indicator
It's a number reflecting a rate ( N/D) for you to ask yourselves
*How far am I from the standard figure
*Or am I satisfied with the number
* can I improve it by improving our performance
* how can we improve our performance
Feedback to Q&AD and it's importance
eg of indicators report from life: Bill from MoE
Shows fig of how much is your electricity consumption in relation to cost
What would be your reaction if it is high?
Investigate is it due to error in reading
Or it's actual
What next if actual?
You would take serious actions in cutting off unnecessary consumption which reflect on reducing cost.!!
Next MoE Bills are your way to find out if actions are effective & whether maintained or not
This example is compatible with Q&AD reporting of indicators
As the directorate gathers the data & provide you with the figures For you to act upon them as you know more about your practices & hospital.

6. Dimensions of Care Structure Process Outcome Human Resources Buildings
Equipment
Supplies
Finance
Process
Assessment
Admission & Discharge
Procedures
Medication
Investigation
Outcome
Test results
Mortality
Morbidity
Complications
Satisfaction

7. Rate-based or Sentinel
uses data about events that are expected to occur with some frequency
Sentinel
identifies individual events or phenomena that are serious, undesirable, and always trigger further analysis and investigation

8. Generic or Disease-Specific
Can be applied to most patients
Disease-Specific
Specific to a particular clinical condition/disease

9. Indicators Development
Choose area to evaluate
High volume
High risk
High cost
Problem prone
Variability in practice
Availability of guidelines/indicators
Actionable
Diagnosis
Specialty
Procedure

10. Criteria for area selection
Total score
Rank
High volume
Practice Gap
Guidelines
Actionable

11. Criteria for area selection
Total score
Rank
High volume
Practice Gap
Guidelines
Actionable
1. Lab test orders duplicated
2. Identification Errors
3. Specimen identification, preparation, and
transport
4. Analytical Errors
5. Reporting Delays

12. Criteria for area selection
Total score
Rank
High volume
Practice Gap
Guidelines
Actionable
1. Lab test orders duplicated 3 12
2. Identification Errors 2 11
3. Specimen identification, preparation, and
transport 1 8
4. Analytical Errors 10
5. Reporting Delays 7

13. Criteria for area selection
Total score
Rank
High volume
Practice Gap
Guidelines
Actionable
1. Lab test orders duplicated 3 12 1
2. Identification Errors 2 11
3. Specimen identification, preparation, and
transport 8 4
4. Analytical Errors 10
5. Reporting Delays 7 5

14. Criteria for area selection
Total score
Rank
High volume
Practice Gap
Guidelines
Actionable
1. Lab test orders duplicated 3 12 1
2. Identification Errors 2 11
3. Specimen identification, preparation, and
transport 8 4
4. Analytical Errors 10
5. Reporting Delays 7 5

15. Indicators Development
Choose area to evaluate
Organize indicator team
Relevant level of field specialists or groups
Readiness and commitment
Reasonable size (8-12)
Planned meetings
Time management

16. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Scientific literature
Pubmed
BMJ
Google Scholar
Consensus about existing evidence/practice

18. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
qualitymeasures.ahrq.gov/

19. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Feasibility
Easily available data collection process
Relevance
Relevant to important aspects of quality
Reliability
Available and reliable data sources
qualitymeasures.ahrq.gov/
Validity
Strong correlation with the current quality of care
Robust
Statistically adequate number of event to be monitored

20. Criteria for Indicator selection
Total score
Rank
Feasible
Reliable
Valid
Robust
Relevant 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.

21. Criteria for Indicator selection
Total score
Rank
Feasible
Reliable
Valid
Robust
Relevant
1. Indicator 1 2 1 3 12
2. Indicator 2 10
3. Indicator 3 11
4. Indicator 4
5. Indicator 5
6. Indicator 6 7 4 7. 8. 9.
10.

22. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Describe design specifications
Information Set
Define indicators and standards
Identify target population
Determine inclusion and exclusion criteria
Devise risk adjustment strategy
Identify data sources
Describe data collection procedures
The target population refers to the patient group whose care the clinical indicator is designed to assess. Specific inclusion and exclusion criteria have to be defined. It should also be decided whether the selection should be based on confirmed diagnoses, or symptoms or signs. Whether prevalent or incident cases (or both) are included should also be taken into consideration. It might be relevant to describe upper or lower age limits. Finally, decisions about the time period for measurement should be taken.
Data Collection Form

23. Numerator & Denominator
Total Population
Denominator
Denominator Excluded Population
Numerator
Numerator Excluded Population

24. Measure ID:
Measure Set:
Measure Name:
Measure description:
Numerator Statement:
Numerator Excluded Population:
Numerator Data Elements:
Denominator Statement:
Denominator Excluded Population:
Denominator Data Elements:
Rationale:
Type of Measure:
Data reported as:
Improvement as:
Sampling:
References:
Risk adjustment:
Suggested analysis:
Definitions:
Frequency of analysis:
Age Group:
Data Sources:
Data Collection Form:

25. Timely follow-up of abnormal test results
All Tests
Abnormal test results
Normal sample results
Records of documented follow-up of abnormal test results

28. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Describe design specifications
Pilot the indicator
Test Reliability and Validity
Reliability of a clinical indicator expresses the extent to which repeated measurements of a stable phenomenon by different providers and instruments, at different times and places, obtain similar results. Reliability is important for comparing groups or comparing the same group over time periods. Reliability can be tested as inter-rater reliability, where different people or methods provide data on the same indicator. Reliability can also be tested as internal consistency, for which two indicators, expected to measure the same aspect of quality of care, are compared. Measuring inter-rater reliability, internal consistency, and test–re-test reliability allows users to determine if the data collection methods are precise enough to provide reproducible results. These methods assess data quality powerfully and identify whether the measure and data collection procedures are well specified.
Validity determines the degree to which an indicator measures what it is intended to measure, that is whether the results of a measurement corresponds to the true state of the phenomenon being measured. Validity can be tested by confirming that the scores of a measure are linked to specific outcomes, and that the measure can reflect good and bad quality.

29. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Describe design specifications
Pilot the indicator
Utilization of indicators
Identify target audience
Results feedback methods
Poor performance actions

30. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Describe design specifications
Pilot the indicator
Utilization of indicators
Update, review and revision
Regular & Periodic

31. Indicators Development
Choose area to evaluate
Organize indicator team
Literature & evidence review
Select indicators
Describe design specifications
Pilot the indicator
Utilization of indicators
Update, review and revision

32. Thank You
Questions?
Dr Hanaa Al-Ghanim