measure for improvement
DESCRIPTION
How do we know a change is an improvement and how could we measure it as well as how to manage it.TRANSCRIPT
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