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

a qualitative analysis of individual and focus group interviews ...

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Balancing Measures (looking at a system from different directions/dimensions): Are changes designed to improve one part of the system causing new problems ... Skiptomaincontent YouarehereHome Archive Volume27, Issue7 Balancingmeasuresorabalancedaccountingofimprovementimpact:aqualitativeanalysisofindividualandfocusgroupinterviewswithimprovementexpertsinScotland Emailalerts ArticleText Articlemenu ArticleText Articleinfo CitationTools Share RapidResponses Articlemetrics Alerts PDF Originalresearch Balancingmeasuresorabalancedaccountingofimprovementimpact:aqualitativeanalysisofindividualandfocusgroupinterviewswithimprovementexpertsinScotland http://orcid.org/0000-0002-0731-9861MadalinaToma1,TobiasDreischulte2,NicolaMGray1,DianeCampbell3,BruceGuthrie4 1 ScottishImprovementScienceCollaboratingCentre(SISCC),UniversityofDundeeSchoolofNursingandHealthScience,Dundee,UK 2 NHSTayside,Dundee,UK 3 ImprovementAcademy,NHSTayside,Dundee,UK 4 Quality,SafetyandInformaticsResearchGroup,PopulationHealthSciencesDivision,UniversityofDundeeSchoolofMedicine,Dundee,UK Correspondenceto DrBruceGuthrie,ScottishImprovementScienceCollaboratingCentre(SISCC),UniversityofDundeeSchoolofNursingandMidwifery,11AirliePlace,DundeeDD14HJ,UK;B.Guthrie{at}dundee.ac.uk AbstractBackgroundAsqualityimprovement(QI)programmeshavebecomeprogressivelylargerscale,therisksofimplementationhavingunintendedconsequencesareincreasinglyrecognised.Moreroutineuseofbalancingmeasurestomonitorunintendedconsequenceshasbeenproposedtoevaluateoveralleffectiveness,butinpracticepublishedimprovementinterventionshardlyeverreportidentificationormeasurementofconsequencesotherthanintendedgoalsofimprovement.MethodsWeconducted15semistructuredinterviewsandtwofocusgroupswith24improvementexpertstoexplorethecurrentunderstandingofbalancingmeasuresinQIandinformamorebalancedaccountingoftheoverallimpactofimprovementinterventions.Datawereanalysediterativelyusingtheframeworkapproach.ResultsParticipantsdescribedtheconsequencesofimprovementintermsofdesirability/undesirabilityandtheextenttowhichtheywereexpected/unexpectedwhenplanningimprovement.Fourtypesofconsequencesweredefined:expecteddesirableconsequences(goals);expectedundesirableconsequences(trade-offs);unexpectedundesirableconsequences(unpleasantsurprises);andunexpecteddesirableconsequences(pleasantsurprises).Unexpectedconsequenceswereconsideredimportantbutrarelymeasuredinexistingprogrammes,andanimprovementpausetotakestockafterimplementationwouldallowthesetobemoreactivelyidentifiedandmanaged.Abalancedaccountingofallconsequencesofimprovementinterventionscanfacilitatestaffengagementandreduceresistancetochange,buthastobeoffsetagainstthecostofadditionaldatacollection.ConclusionImprovementmeasurementisusuallyfocusedonmeasuringintendedgoals,withminimaluseofbalancingmeasureswhichwhenused,typicallymonitortrade-offsexpectedbeforeimplementation.Thispaperproposesthatimproversandleadersshouldseekabalancedaccountingofallconsequencesofimprovementacrossthelifeofanimprovementprogramme,includingdeliberatelypausingafterimplementationtoidentifyandquantitativelyorqualitativelyevaluateanypleasantorunpleasantsurprises. healthcarequalityimprovementqualitymeasurementqualitativeresearchpatientsafetyimplementationscience http://dx.doi.org/10.1136/bmjqs-2017-006554 StatisticsfromAltmetric.com healthcarequalityimprovementqualitymeasurementqualitativeresearchpatientsafetyimplementationscienceViewFullText FootnotesContributorsMTandBGwereresponsibleforplanningthestudyandledthedatacollectionandanalysis.TD,NMGandDCcontributedtodataanalysis.MTdraftedandledthewritingofthemanuscript.BG,TD,NMGandDCparticipatedincriticallyappraisingandrevisingtheintellectualcontentofthemanuscript.Allauthorsreadandapprovedthefinalmanuscript.FundingThispaperpresentscoreworkfromtheScottishImprovementScienceCollaboratingCentre,fundedbytheScottishFundingCouncil,HealthFoundation,ChiefScientistOffice,andNHSEducationScotlandwithin-kindcontributionsfromparticipatingpartneruniversitiesandhealthboards.Thefundingbodieshadnoroleinthedesignofthestudyandcollection,analysisandinterpretationofdata,andinwritingthemanuscript.CompetinginterestsNonedeclared.PatientconsentDetailhasbeenremovedfromthiscasedescription/thesecasedescriptionstoensureanonymity.Theeditorsandreviewershaveseenthedetailedinformationavailableandaresatisfiedthattheinformationbacksupthecasetheauthorsaremaking.EthicsapprovalTheUniversityofDundeeResearchEthicsCommitteegrantedethicalapprovalforthisstudy(UREC15069).ProvenanceandpeerreviewNotcommissioned;externallypeerreviewed.DatasharingstatementThedatausedand/oranalysedduringthecurrentstudyareavailablefromthecorrespondingauthoronreasonablerequest. 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