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

1. Measurement for improvement
Musa Abu Sbeih
Nursing Affairs Department
Al-Massarra Hospital

2. Question?
How do we know a change
is an improvement?

3. Definition
Measurement: The systematic collection of
quantifiable data about both processes and
outcomes overtime or at single point in time.

4. 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 “

5. Establishing Your Baseline

7. 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

8. 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

9. 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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10. What do we Measure?

11. Is Productivity different from Performance

12. Formats of Measures

14. Quiz

15. • 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?

16. • 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
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Quiz: Which are measures?

17. System Components

18. Process Outcomes
Structure
Donabedian, A. Evaluating the Quality of Medical Care. Milbank Memorial Fund Quarterly 44:166–203, 1966
O = S + P

19. Types of Measures

21. Examples

22. 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

23. 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 Measures
1. Average length of stay (ALOS)
2.Number of calls to the crisis intervention team
3. Percent compliance with break away techniques
4. Percent compliance with hand hygiene
5. Percent achievement of multi-disciplinary rounds and daily goals
6.Percent compliance with using safety briefings
7.Percent compliance with using SBAR
Balancing Measure
1. Staff satisfaction in Female acute

25. Cause and effect diagram
Social issues Staff attitudes Complications
Procedure
Patient perception Post discharge support
Prolonged
LOS
Atypical Drugs
Diagnosis
nutrition
Treatment Protocol
LOS
Team work
communication
Cost mind
expect long LOS
home support
often 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

26. 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

27. 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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28. Mesosystem
Macrosystem
Microsystem
Nursing
Services
Nursing
Divisions
Frontline
Nursing
Units
Example
Source: Hendriks & Bojestig, Jonkoping CC Sweden
System Levels

29. Application Exercise
(10 minutes)

30. 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.

31. References
1. 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