Measurement_and_Data_in_Quality_Improvement.ppt

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1. Measurement and Data in Quality
Improvement - Overview
The Quality Academy
Tutorial 7

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Learning Objectives: You Will Learn About…
•Using measurement to support improvement rather
than as an end in itself
•Taking key steps towards improvement: measure,
assess variation, act on data findings
•Creating an environment where measuring
performance is helpful
Learning Objectives

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Key Question
Why is measurement so important
to quality, and how does
measurement support quality
improvement?
Using Measure to Support Improvement

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Pop Quiz
Using Measure to Support Improvement

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Answer: 73.0%
• This is a performance measure
• What can we do with it?
• Determine levels of improvement
• Evaluate when counseling occurs
• Assess whether changes make a difference
Using Measure to Support Improvement

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Why Measure?
It’s very simple:
“You can’t improve what you can’t measure!”
Using Measure to Support Improvement

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Measurement and Quality Improvement are Interlinked
Using Measure to Support Improvement

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Evaluating Variation is Important
“While deciding what to measure and how to
measure it are important challenges, an
equally important challenge lies in
determining the appropriate reaction to the
measurement once we have it.”
- Paul E. Plsek
Using Measure to Support Improvement

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Yes
Measure
Decide
Evaluate
Need
to
Improve?
Clarify
Define
goal
Analyze
work
process
Plan and
test
change
Assess
the test
Make the
change
The Improvement Process
No
Achieving
goal?
Yes
No

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Example 1: Not a Lot of Variation
Percent of Eligible Patients on ARV Treatment
Adherence Assessment, CY 2005
0%
20%
40%
60%
80%
100%
JanFebMar AprMay Jun JulAugSeptOctNov Dec
Taking Steps Towards Improvement

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Example 2: What’s Going on Here?
Percent of Eligible Patients on ARV Treatment
Adherence Assessment CY 2005
0%
20%
40%
60%
80%
100%
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Taking Steps Towards Improvement

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Evaluating Variation
•The system of causes of variation are constant or
common to all cases: common cause variation
•The system of causes of variation are not constant
or not common to all cases: special cause variation
Taking Steps Towards Improvement

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Acting on Variation
Taking Steps Towards Improvement

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Beware of Tampering
“ When action is taken on a process under
the assumption that variation is a result
of special cause when, in fact, the
variation is a result of common causes.”
(Nolan & Provost)
Creating a Measurement-friendly Environment

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Examples of Tampering
Changing the number of
appointments booked when
the clinic has two weeks of
low (but not unusually low)
patient visits
Criticizing a visiting nurse
for making fewer home
visits than the others in the
HIV outreach program
Praising a physician for
having the shortest clinic
waiting time
Creating a Measurement-friendly Environment

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Determining the Difference
•Plot data over time
•Look for trends or
patterns
•If you know them, use
more sophisticated tools
like control charts
Creating a Measurement-friendly Environment

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Identifying Trends and Patterns
Apply “Berkson’s Interocular Traumatic Test” (per Harry Roberts)
•Six consecutive data points trending in one direction
•Obvious clumping
•Repeating patterns
Creating a Measurement-friendly Environment

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Tampering is Bad Because
It can make
things worse,
rather than better
It frustrates and
demoralizes staff
It leads to
distrust of data
Creating a Measurement-friendly Environment

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Avoid the Cycle of Fear
Creating a Measurement-friendly Environment
Increase fear
Kill the messenger
Filter the information
Micromanage

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To Break the Cycle of Fear:
•Involve others in the development of measures
•Share data reports and measurement results
with leadership, staff, consumers
•Listen to people’s explanations of data results
•Understand tampering, and don’t do it!
Creating a Measurement-friendly Environment

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Key Points
•You can’t improve what you can’t measure
•But... measurement is part of a larger improvement
journey
•Until they get comfortable with it, many staff may
view measurement as threatening. Pay attention to
creating a sense of ownership of measurement
among the staff
Key Points

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Resources
•Carey, Raymond G., Ph.D., Improving Health Care with Control Charts.
Milwaukee: ASQ Quality Press, 2003
•Measuring Clinical Performance: A Guide for HIV Health Care
Providers. A publication of the AIDS Education Training Centers and
the New York State Department of Health, AIDS Institute, 2002. The
guide can be downloaded at:
http://www.hivguidelines.org/public_html/center/quality-of-care/perfo
rm_guide/perform_guide.pdf
.
•Roberts, Harry, Quality Is Personal, New York:Free Press, 1993
Resources

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Related Tutorials
•To learn more about defining quality
indicators, study Tutorial 8
•To learn more about data collection, study
Tutorial 9
•To learn more about how to link data results
to quality improvement activities, study
Tutorial 10
Related Tutorials

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The Quality Academy
For further information, contact:
National Quality Center
New York State Dept. of Health
90 Church Street, 13fl
New York, NY 10007-2919
Work: 212.417.4730
Fax: [phone]
Email: [email protected]
Or visit us online at www.NationalQualityCenter.org
In Closing