Science of Improvement: Establishing Measures | IHI

Use a balanced set of measures for all improvement efforts: outcomes measures, process measures, and balancing measures. Outcome Measures. Pleasewaitwhileyouarebeingredirected... ThissiteisbestviewedwithInternetExplorerversion8orgreater.CheckyourbrowsercompatibilitymodeifyouareusingInternetExplorerversion8orgreater. LogIn/Register Extranet EducationPlatform NewsletterSignUp NewsletterSignUp Blog Careers Donate Home AboutUs Topics Education Resources Regions EngagewithIHI MyIHI Home AboutUs Vision,Mission,Values EquityIsOneofIHI'sValues History ScienceofImprovement Innovation People HowtoGetInvolved IntheNews Finances Careers Contact KnowledgeBase Topics AllTopicsA-Z COVID-19 HealthEquity ImprovementCapability JoyinWork Leadership PatientSafety Person-/Family-CenteredCare TripleAimforPopulations ValueManagement Education EducationOverview IHIForum IHIPatientSafetyCongress Conferences In-PersonTraining VirtualTraining CertifiedProfessionalinPatientSafety(CPPS) IHIOpenSchool Resources ResourcesOverview HowtoImprove Measures Changes ImprovementStories Tools Publications IHIWhitePapers AudioandVideo CaseStudies Regions RegionsOverview Africa Asia-Pacific Europe LatinAmerica MiddleEast NorthAmerica EngagewithIHI EngagewithIHIOverview CustomizedServices Initiatives MembershipPrograms FellowshipPrograms StrategicPartnerships IndustryPartnerships Blog UserGroups Home / Resources /HowtoImprove/ ScienceofImprovement:EstablishingMeasures HowtoImprove Resources Resources HowtoImprove Measures Changes ImprovementStories Tools Publications IHIWhitePapers AudioandVideo CaseStudies IHILRWide ScienceofImprovement:EstablishingMeasures PageContent ​ModelforImprovement:Howwillweknowthatachangeisanimprovement?Measurementisacriticalpartoftestingandimplementingchanges;measurestellateamwhetherthechangestheyaremakingactuallyleadtoimprovement.Measurementforimprovementshouldnotbeconfusedwithmeasurementforresearch.Thisdifferenceisoutlinedinthetablebelow. MeasurementforResearch MeasurementforLearningandProcessImprovement PurposeTodiscovernewknowledgeTobringnewknowledgeintodailypractice TestsOnelarge"blind"testManysequential,observabletests BiasesControlforasmanybiasesaspossibleStabilizethebiasesfromtesttotest DataGatherasmuchdataaspossible,"justincase"Gather"justenough"datatolearnandcompleteanothercycle DurationCantakelongperiodsoftimetoobtainresults"Smalltestsofsignificantchanges"acceleratestherateofimprovement Seealso: TipsforEffectiveMeasures. The WholeSystemMeasures,asetofhealthsystemperformancemeasures,keyedtothesixdimensionsofqualityoutlinedbytheInstituteofMedicineinthe CrossingtheQualityChasmreport—safe,effective,patient-centered,timely,efficient,andequitable—thatcanbeusedtoevaluatetheoverallperformanceofahealthsystem.  ThreeTypesofMeasures Useabalancedsetofmeasuresforallimprovementefforts:outcomesmeasures,processmeasures,andbalancingmeasures. OutcomeMeasuresHowdoesthesystemimpactthevaluesofpatients,theirhealthandwellbeing?Whatareimpactsonotherstakeholderssuchaspayers,employees,orthecommunity?Fordiabetes:AveragehemoglobinA1clevelforpopulationofpatientswithdiabetesForaccess:Numberofdaysto3rdnextavailableappointmentForcriticalcare:IntensiveCareUnit(ICU)percentunadjustedmortalityFormedicationsystems:Adversedrugeventsper1,000doses ProcessMeasuresAretheparts/stepsinthesystemperformingasplanned?Areweontrackinoureffortstoimprovethesystem?Fordiabetes:PercentageofpatientswhosehemoglobinA1clevelwasmeasuredtwiceinthepastyearForaccess:AveragedailyclinicianhoursavailableforappointmentsForcriticalcare:Percentofpatientswithintentionalroundingcompletedonschedule. BalancingMeasures(lookingatasystemfromdifferentdirections/dimensions) Arechangesdesignedtoimproveonepartofthesystemcausingnewproblemsinotherpartsofthesystem?Forreducingtimepatientsspendonaventilatoraftersurgery:MakesurereintubationratesarenotincreasingForreducingpatients'lengthofstayinthehospital:Makesurereadmissionratesarenotincreasing SampleMeasuresSeethe Measuressectionforsamplemeasures. UsingSampling:AnExample HereishowoneteamusedsamplinginmeasuringthetimefortransferfromEmergencyDepartment(ED)toinpatientbed. RapidmovementfromtheEmergencyDepartment(ED)afteradecisiontoadmitthepatientiscriticalflowforentrytotheentiresystemforemergentpatientcare.Itrepresentstheabilityofpatientswithvariousillnessestogetintothesystemthroughthemostcommonadmissionroute.  Samplingapproach:Themeasurementwillconsistof6weeklydatacollectionsof25patientseach.Thepatientscanbesampledinseveralways:5patientsperdayfor5daysoftheweek.Thepatientsmustbeconsecutiveandatleastonedaymustbeaweekendday. or25consecutivepatientsregardlessofanyspecificday,exceptthatitmustincludesomeweekendadmissions. orIftherearefewerthan25admissionsforaweek,thetotaladmissionsfortheweekshouldbeincludedinthesample.Thetimeismeasuredfromthedecisiontoadmittothephysicalappearanceofthepatientintotheinpatientroom.Thedestinationcannotbea"holdingarea"butmustbea"realinpatientbed."Thesamplecollectionshouldbedoneinrealtime,soadatacollectionprocessneedstobeworkedoutbymembersoftheteamtoachievethisgoal.Thecollectionsmustbedoneweeklyandsummarizedasthepercentageofpatientsinthesamplethatachievedthegoalforthatweek.Sixweeksofdataneedstobecollectedandsixdatapointsplacedonarunchart. PlottingDataOverTimePlottingdataovertimeusingarunchart isasimpleandeffectivewaytodeterminewhetherthechangesyouaremakingareleadingtoimprovement.Annotatetheruncharttoshowthechangesyoumade.Youcanusethe ImprovementTrackertoautomaticallyplotyourdataovertime. Example1:  Example2:  AverageContentRating (8users) Pleaseenteracomment. Pleaselogintorateorcommentonthiscontent. UserComments [email protected] 9/14/202011:39:48AM Excellent loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byAlexWilliamson 1/2/20201:18:44PM Excellentvideoforintroducingtheconceptsinarelatableway loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byGeanineDaza 2/24/20192:34:32PM ifIhavethirdavailablealreadycollected,whatwouldbethebestwaytocomparetotheactualhoursphysiciansareinclinictofulfillnewappointments.? loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byJalalJafri 1/26/20184:06:22PM Pleasemakethegraphsclearerforreadability. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byJanetMasters 12/15/20166:12:25PM Ifindtheexplanationsveryhelpful.HoweverIstrugglewithsoftermeasures.Thesearealldealingwithharddata.Butthepatientstoryhasmanyusefulpointsinitaswell-Iambeingaskedtocomeupwithoutcome/process/balancingmeasuresinaprojectbasedonpatientstoriesaboutthesystem. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byM.AliMontazer 8/2/20165:48:13PM Thiswasaveryshortbuteffectiveintroductiontoperformancemeasuresinhealthcare.Thankyouforthetime.Verynice. MAliMontazer loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byM.AliMontazer 8/2/20165:36:11PM Thiswasaveryshortbuteffectiveintroductiontoperformancemeasuresinhealthcare.Thankyouforthetime.Verynice. MAliMontazer loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byMuhammadJumanBahoto 6/21/20161:22:47AM veryuseful loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byDukeRohe 1/24/20168:03:48PM IliketheBalancemeasure.Sometimesit'shardtoidentifyagoodone loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byPeterLiepmann 12/18/20156:19:25PM Goodsummary. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» ShowMoreComments... Loading... YouareabouttoreportaviolationofourTermsofUse.Allreports arestrictlyconfidential. Reason*: SelectOne Containsprofanityorviolence Spam Defamatory Illegal/Unlawful CopyrightViolation Other Pleaseselectareasonforthisreport. AddaNote: Yourcommentsweresubmittedsuccessfully. Therewasanerrorreportingyourcomplaint. HowtoImprove Introduction FormingtheTeam SettingAims EstablishingMeasures SelectingChanges TestingChanges ImplementingChanges SpreadingChanges FeaturedContent first< >last ControlCharts(Part1) RobertLloyd,theDirectorofPerformanceImprovementatIHI,useshistrustywhiteboardtodissectthescienceofimprovement.Inshortvideos,hebreaksdowneverythingfromDeming'sSystemofProfoundKnowledge,tothePDSAcycle,toruncharts. RunChartTool Runchartsaregraphsofdataovertimeandareoneofthemostimportanttoolsforassessingtheeffectivenessofchange. RunCharts(Part1) RobertLloyd,theDirectorofPerformanceImprovementatIHI,useshistrustywhiteboardtodissectthescienceofimprovement.Inshortvideos,hebreaksdowneverythingfromDeming'sSystemofProfoundKnowledge,tothePDSAcycle,toruncharts. WholeSystemMeasures Thiswhitepaperdescribesandpromotestheuseofasystemofmetrics,calledtheWholeSystemMeasures,tomeasuretheoverallqualityofahealthsystemandtoalignimprovementworkacrossahospital,grouppractice,orlargehealthcaresystem. MoreonThisTopic LoadingPages.... first < > last AnIntegratedApproachtoQuality Thisarticledescribeshowwholesystemquality,anintegratedorganization-wideapproachtoquality,canhelphealthcareleadersbuildmoreresponsiveandresilienthealthsystems. BetterMaternalOutcomesQualityImprovementWorkbooks ​DevelopedaspartoftheBetterMaternalOutcomesRapidImprovementNetwork,theworkbookscontaindescriptions,examples,andtemplatesfortoolsthatteamscanusetoguidetheirqualityimprovement(QI)workfocusedonimprovingmaternalhealthoutcomesandequity. TacklingSystemicRacisminMaternityCare ABrazilianhealthcollaborativeusesimprovementscienceandtheconceptof“liberatoryconsciousness”toaddressracisminmaternitycare. WholeSystemQuality Thiswhitepaperdescribesamoreholisticapproachtoqualitymanagementthatintegratesqualityplanning,qualitycontrol,andqualityimprovementactivitiesacrosstheorganization,supportedbyleadershippracticesthatfosteracultureoflearning. 100MillionHealthierLives:UsingImprovementSciencetoAccelerateCommunityTransformation Thiscollectionofresources,developedaspartofthe100MillionHealthierLivesinitiative(100MLives),providespracticalguidanceonhowtouseimprovementmethodsandtoolsincommunity-basedsettingstoadvancehealth,well-being,andequity. ViewAll TakeaFreeQICourse Learnthefundamentalsofimprovementwiththisonlinecourse,freewithregistrationonihi.org: QI102:HowtoImprovewiththeModelforImprovement