There are so many measures that are collected within the healthcare field:
Hospital readmission rates, mortality rates, sepsis rates, and patient satisfaction scores, to name a few.
Why do we collect these measures, and for what purpose?
The general sense is that we collect measures for the purpose of driving positive change over a specific period of time, to ultimately improve patient outcomes. The quality improvement field generally categorizes measures into three categories: outcome, process and balancing measures.
Outcome measures: indicates how well the healthcare system is performing
Process measures: indicates how well the workflow of the healthcare system is performing
Balancing measures: Is one aspect of the system being negatively impacted by another part, as a result of an implemented change?
When planning to implement measures as part of a health quality improvement initiative, it is critical to gain a clear understanding of what you intend to measure before implementing these measures.
Once you undergo a quality improvement initiative and change management training to get clinicians and administrative staff on board, it can be difficult to reverse this process. Especially when you involve financial incentives around the success of measures.
One exercise I would suggest doing, before implementing measures, is to take the time to do the 5 Whys Root Cause Analysis technique, developed in the 1930s by Sakichi Toyoda, the founder of Toyota Industries. The purpose of this technique is to not only clearly identify the problem that is looking to be solved but also uncovering hidden processes linked to the problem that might not be immediately clear.
In the book Clear Thinking by Shane Parrish, there is a case study about the founder, Lori, the owner of a downtown dog rescue in LA, who went against the grain of thinking of what most shelters were focused on: “How can we get more people to adopt dogs?”
She instead looked at what would have to be true for there to be fewer dogs to adopt, she dug into the data and looked into why do people give up their dogs?
She found that owners surrendered their pets because they couldn’t afford to feed them. With this information, she started a new program. When a family came to the shelter to give up their dog, she would ask them if they would prefer to keep their pet, and her staff would work with their network to help the family with resources (e.g., food, low-cost medications).
Without this deeper thinking, Lori might have focused her efforts on developing a measure that was focused on short-term sustainability instead of long-term sustainability, and I believe more of this thinking should be applied to the healthcare field.
Most hospital systems are focused on how to reduce emergency department (ED) visits, as overcrowding in the emergency department is a common issue. One might want to focus all their efforts on this measure by simply looking at how many ED visits occurred in one month and making sure there is a reduction in the following month.
However, in a previous newsletter, I mentioned that 1 in 5 people don’t have a primary care provider. According to the Canadian Institute for Health Information, across Canada, 15% of visits to the ED between April 2023 and March 2024 were for conditions that could potentially have been managed in a primary care setting. When thinking of selecting measures, we need to focus our efforts on long-term sustainability. This might look like identifying how many individuals have a primary care provider and how many patients are visiting the ED, with symptoms that could be managed by their primary care provider.
0 Comments