Balancing measure exampleOutcome measureProcess measureFamily of measuresChange conceptsbalancing measure exampleQuality measureImprovement measuresOutcome measuresProcess measurementOutcome measure example

Step 5: Establish Measures - Network for Improvement and ...

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Balancing Measures: Are changes designed to improve one part of the system causing new problems in other parts of the system? We typically establish 5-8 ... “InGodWeTrust. AllOthersMustBringData” –W.EdwardsDeming   Measurementisatthecoreofimprovementandhasanessentialroleineffectivelydeveloping,testing,andimplementingchanges. MeasurementhelpsusanswerthesecondquestionintheModelforImprovement: “Howwillweknowachangeisanimprovement?” Withoutfeedback,wehavenowayofknowingwhetherthechangeswearemakingareleadingtoimprovement.Datausuallyprovidethemostusefulandobjectiveformoffeedback. BytheendofStep5,youshouldbeableto: establishthe“familyofmeasures”foryourproject,includingprocess,outcome,andbalancingmeasures operationalizeeachmeasure developameasurementplan ImportanceofMeasurementforImprovement Measurementinqualityimprovementallowsustounderstandwhetherwehavereachedourimprovementaims.Todoso,wemustdefineandoperationalizewhat‘better’lookslikeandmeasuretoknowifthechangeswemakeresultintheimprovementsweseek. Measurementforimprovementallowsustoanswerquestionssuchas: Whatisthecurrentstate? Whatdoes“better”looklike? Howwillwerecognizebetterwhenweseeit? Whatarefactors,suchasprocessesandactivities,haveanimpacttheoutcomes? Aretheprocessesstableandreliable? Howdoweknowifachangeisanimprovement? Thegraphicbelowdepictssomeofthedifferentwaysthatmeasurementanddatasupporteachstepthroughoutourimprovementjourney(clicktoenlarge): Qualityimprovementrequiresacomprehensiveunderstandingofthesystemorhowthevariousprocessesworktogethertoachieveoutcomes. Establishinga“familyofmeasures,”providesaviewofthesystemfromtheoutcomes,totheprocesses,totheunintendedimpacts. Theapproachbelow,coinedbyRobertLloydastheMeasurementJourneyModel,helpsusestablishvalidandactionablemeasurementtosupportourimprovementprojects. Source:Lloyd,R.QualityHealthCare:aguidetodevelopingandusingindicators.Jones&BartlettPublishers2004 Takingthetimetodevelopaformal“MeasurementPlan”canhelpmeasurewithapurposeandpreventspendingexcessivetimeandresourcesonunnecessarymeasurementefforts. Measurementplansoutlinetheanswerstoquestionsof-what,how,where,whenandbywhominthedatacollectionprocess.Engagingallteammembersinthecreation,communication,andupkeepofthemeasurementplancreatesgreaterunderstandingoftheoutcomesyouaretryingtoachieveandfacilitatesallotheraspectsoftheimprovementjourney. Whattypesofmeasuresarethere? Whenwecreateourfamilyofmeasuresforanimprovementproject,wealwayswanttotrytoincludeabalancedsetofmeasuresthatassessprocessesandoutcomesaswellasidentifyingbalancingmeasures. OutcomeMeasures: Howdoesthesystemimpactthevaluesofstudents,theirhealthandwellbeing?Whatareimpactsonotherstakeholderssuchaspayers,employees,orthecommunity? ProcessMeasures: Aretheparts/stepsinthesystemperformingasplanned?Areweontrackinoureffortstoimprovethesystem? BalancingMeasures: Arechangesdesignedtoimproveonepartofthesystemcausingnewproblemsinotherpartsofthesystem? Wetypicallyestablish5-8measures,aspartofourfamilyofmeasures,whencarryingoutanimprovementproject. TopicOutcomeProcessBalancing Waittimeforwalk-invisittimefromcheck-intostartofproviderassessment PatientSatisfaction Lengthoftimetocheck Staffsatisfaction Depressioncare%ofstudentsoncampuswhoreportacademicimpactfromdepression%ofstudentsscreenedfordepressioninmedicalservices. %ofstudentsengagedintreatmentwithin2weeksofpositivescreen Appointmentavailabilityincounselingservices Bingedrinking%ofstudentsoncampuswhobingedrink %ofstudentsoncampuswhoexperienceanegativeconsequencefromalcohol%ofenteringstudentswhocompleteonlinealcoholeducationalmodule %ofstudentsscreenedforhighriskdrinking ofthosestudentswhoscreenpositive,%ofstudentswithadocumentedthatbriefmotivationalinterviewinterventionwasconducted. %ofstudentsoncampuswhoaretrainedonbystanderintervention %studentsreportingthattheyreceivedinformationfromtheirschoolonother(non-alcohol)relatedtopics DifferencesbetweenMeasurementforJudgementversusResearchversusImprovement Measurementforimprovementisdistinctlydifferentfrommeasurementforresearchorjudgement. Thesedifferencesareoutlinedinthetablebelow. Adaptedfrom: “TheThreeFacesofPerformanceManagement: Improvement,AccountabilityandResearch.”Solberg,LeifI.,Mosser,GordonandMcDonald,Susan. JournalofQualityImprovement. March1997,Vol23,No.3. MeasurementTips Ifachangeisnotworking,adjustit.Theabilitytomakeadjustmentsalongthejourneytoimprovementisnotaweaknessofthestudydesign;itisanessentialelementofit. Acceptthatvarioustypesofbiascanexistinthedata. Ratherthanattempttoeliminatebiasbycontrollingforit,trytokeepthecontextandbiasconsistentovertime. Improvementresearchdoesnottakeplaceinisolated,controlledconditions;typically,ithappensinrealworldsettings.Testingchangesinthecontexttheywillbeimplemented(“realworldsettings”)isanessentialsourceoflearningabouthowtomakethechangeworkreliably:foreverystudent,everytime,ineverycontext. Wheneverpossible,developmeasuresfromdatathatisalreadybeingcollected.That’llmakeyourprojectalotsimplerwithoutcompromisingonquality.Whenit’snecessarytodevelopnewmeasures,trytomakethedatarelativelyeasytoobtain.   ImprovementJourneyExercise#5 Establishthe“familyofmeasures”foryourproject,includingprocess,outcome,andbalancingmeasures Operationalizeeachmeasure&documentyour measurementplanusingthe MeasurementPlanningForm   Onceyouhaveoperationalizedyourmeasurementplan,moveontoStep6:DevelopIdeasforChange. ImprovementJourneyToolsAdditionalResources

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