Measurement in Greater Detail
What are we trying to accomplish?
• Idea of cascading measures
• Revisiting our team level dashboards
• Measurement for PDSA cycles
System of Feedback
O1
B
O2
B
Measure Types
O = Outcome Measure
P = Process Measure
P1
S1
P2
S2
S3
P1
P2
B = Balance Measure
S = Process Step
Measure
S1
S2
S3
= Learning Cycle
Measure
PDSA
PDSA
PDSA
PDSA
PDSA
1
2
PDSA
4
PDSA
3
PDSA
PDSA
1
2
4
3
© Improvement Science Consulting
System of Feedback
(Hip Fracture)
O - Mortality O – Patient Satisfaction
B
B
Measure Types
O = Outcome Measure
P = Process Measure
P - ALOS
S1
P1
S2
P2
B = Balance Measure
S = Process Step
Measure
S – Time to Theatre S1
S2
S3
= Learning Cycle
Measure
PDSA
PDSA
PDSA
PDSA
PDSA
1
2
PDSA
4
PDSA
3
PDSA
PDSA
1
2
4
3
© 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
Sequence of learning and change
Evidence
primarily
Qualitative
Very small
scale test of a
change idea
Evidence primarily
Quantitative with
noticeable impact on
process measures
Large scale test of
change idea or
Implementation of a
change idea
© 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?
Example 1
(CLAB Insertion
Bundle)
Development
Testing
Implementation
Acceptance of drape
Availability of pre-pack
Compliance to individual
elements or orprocess
steps (hat use)
Compliance to the bundle
(focus on change) undering
varying conditions
CLAB rate on the ward
Compliance to the bundle
(focus on monitoring)
Cost of pre-packs per
month
Infection Rate (small
multiples by ward and
aggregate at facility)
Example 2
Example 3
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
Example 1
(CLAB Insertion
Bundle)
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)
Example 2
Example 3
Creating dynamic insight into
improvement
Outcome Measure(s)
Process Measures
Get movement
here by
Balance Measure(s)
Process Step Measures
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
What are we trying to
accomplish?
What change can we make
that will result in improvement?
How will we know that a change
is an improvement?
Act
Plan
Study
Do
Langley, et al.