1. Scottish Improvement Skills
Planning measurement
SIS: Group C Measurement: Module – Planning measurement: Facilitator

2. System of Profound Knowledge
For this session we are in this part of the System of Profound Knowledge: Understanding Variation.
Aims
To create operational definitions for your project
To create a measurement plan
Subsidiary aim depending on how challenging participants find this module:
To be able to distinguish between different types of measure (count, %, and rate) and explain how to define a % and rate
Key messages
Importance of planning measurement and everyone who may collect data having a shared understanding of each measure and how to collect the data
Importance of defining measures early in the project.
Timing
60 mins minimum for the whole module
Deming 2000

3. Planning measurement By the end of this session you will be able to:
Create operational definitions for your measures that others can follow reliably to collect data
Create a measurement plan for your improvement work.
Learning outcomes: Lead Facilitator read out or ask participants to read
Recap from Introduction to Measurement – elicit 3 types of measure and what they are:
Outcome – voice of the customer
Process – voice of the system
Balancing – unintended consequences

4. How big is your banana? DISCOVERY Aim
Participants to be able to explain the importance of a clear, shared understanding of what and how teams are measuring.
Key messages
We need everyone in our team to be clear about what and how we are measuring in our improvement work.
Timing
25 minutes
Materials
For each team:
Banana
Ruler
Paperclip
String – must be long enough to go end to end twice
Paper – 2 sheets
Pen/pencil
And:
Bananas online countdown timer (a mobile phone timer doesn’t work as well as it isn’t as loud, and people tend to ignore it)
Two sets of numbers on paper or card 1 to 5 or 6 (ie to label the teams who first measure, then second measure – 2 different colours may help)
Flip chart sheet prepared with numbers of teams (initial then other team measuring the same banana). Allow plenty of space to write several measures eg if they measured around as well as end to end.
Lead facilitator
Divide the participants into teams. No more than 5-6 teams as the key messages can easily be covered in debriefing on this quantity of examples.
Set up countdown timer.
Support facilitators
Facilitator A: give out materials
Facilitator B: Give each team a number (otherwise they forget later who has which team’s banana)
Instructions
Measure the size of your banana.
Write out instructions for another team to follow so they can repeat the measurement process.
Time limit: 7 minutes
Use whatever pieces of kit you like and decide what measurement(s) to take.
On a separate piece of paper note down the size of the banana - do not share this with anyone at this point.
After 7 minutes they stop.
Faciiltator pass the banana and measurement instructions to the next team i.e. 1 pass to 2 , 2 pass to 3 etc
The next team measures the ‘new‘ banana according to instructions, and writes the measurements down on the instruction sheet.
Give a 4 minute time limit, using the same countdown timer.
If all teams finish before 4 minutes have elapsed, cancel the timer and move on to the debrief.
Debrief:
Lead Facilitator
Note down both measurements for each banana on a flipchart, noting where there are differences in measurement for the same banana. Facilitate discussion about these differences.
Support facilitators must have an opportunity to feed in to this discussion, as it is likely that they will have noticed things the Lead Facilitator may have missed.

5. Operational definitions
Define the specific components of the measure
If it is an average, specify the calculation for deriving the average
If it is a score (eg patient satisfaction score), describe how the score is derived.
If it is a percentage or a rate, specify the numerator and denominator
Describe any special equipment needed
Describe the criteria to determine concepts such as ‘accurate’ or ‘complete’.
PRACTICE
Aim
Participants distinguish between outcome, process and balancing measures
Participants generate alternative measures for the same outcome or process
Key messages
There is usually more than one way we could measure the same thing
Range of criteria for selecting a measure eg historical data or benchmarks, ease of collection. ease of standardisation
What to include in an operational definition (possibly including the difference between a percentage and a rate
Timing
15 minutes
Materials
Case study wall cards:
Aim, drivers and change ideas already on the wall
Measures
Blu tac or Velcro
Lead Facilitator
Picking up from issues arising from bananas re operational definitions, do participants have anything to add to this slide, or any questions?
Facilitators
Depending on the number of participants and facilitators, decide in advance which case studies will be used. All facilitators decide which measures they will use first (it is not necessary to use all the cards, if time is short); make sure at least one example of each of the following is used: count, percentage, rate.
Each facilitator go to one of the case studies, with the Measures cards and blutac/Velcro
For each measure card, ask participants to match it to one of the components of the driver diagram and change ideas, and put the measure on the wall beside the relevant component.
Then elicit:
- whether the measure is O, P or B
- any issues with defining it
- logistical issues eg equipment required, calibration, resources/workload
- possible alternatives to this measure; in which case, which measure might be most suitable and why
And a brief discussion on stratification
If all is going well, highlight (elicit if possible), the difference between a percentage and a rate. If participants are struggling, consider whether or not it will be helpful to introduce this distinction.

6. Project work: measurement planning
Pick one of your measures
Create an operational definition
Consider exclusions and stratifiers
Provide outline data collection method
PROJECT
Aim
Participants become familiar with a standard measurement plan template.
Participants create at least one measurement plan for their project
Timing
20 minutes
Materials
Measurement plan examples
QIHub measurement plan template
QIHub data collection plan template
Consider having participants do this on laptops with preloaded templates
Lead facilitator
Pick one of the measures that you have so far outlined for your project.
Referring to the examples, as well as the case studies on the wall:
Write a detailed operational definition. Best to do this on the back of the sheet, to ensure the message is clear that more space is needed for this than the hard copy template allows.
Complete the other sections of the plan.
Facilitators
Monitor the room.
In particular check that operational definitions have sufficient detail.
Be ready to answer questions about other sections of the plan eg stratifiers, exclusions, sampling.
Options for early finishers:
Draft a measurement plan (starting with the operational definition) for another project measure
Look at the data collection plan template (in particular the guidance notes), which includes more logistical issues, and start drafting.

7. Planning measurement: summary
Aim
To briefly recap the session content:
To support a sense of learning and accomplishment
To aid memory of the session later
An opportunity for participants to ask any outstanding questions from any part of the session
Timing
2 – 5 minutes, depending on time available
Lead facilitator
Elicit key messages from the module eg
What’s the purpose of a measurement plan? (everyone has the same understanding of what you are measuring and how)
What do you need to include?
How many measurement plans do you need? (as many as you have measures)
When do you create measurement plans? (for any new measure, asap to ensure it’s the right measure)
Who should be involved? (not just you eg people who may ‘own’ historical data, people who will be collecting data, people who can help with equipment for measurement)
Planning measurement: summary