As a Healthcare Analyst, imagine you are in a meeting one day, and the Communications team mentions that there have been several negative reviews from patients who don’t feel supported after their hip replacement surgeries. As part of the Quality Improvement team, this project falls on your desk to figure out how to improve the patient experience at your hospital.
In the last newsletter, we reviewed three different types of quality improvement measures:
Outcome measures: indicate how well the healthcare system is performing
Process measures: indicate 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
Before diving into slicing and dicing the available data, you might want to brainstorm with your team what type of measures would be beneficial to the outcome you are hoping to achieve.
The DECIDE framework, designed in 2008 by Professor Kristina Guo, could be used to start outlining this quality improvement project. The DECIDE framework consists of:
D = Define the problem
E = Establish the criteria
C = Consider all the alternatives
I = Identify the best alternative
D = Develop and implement a plan of action
E = Evaluate and monitor the solution
To help with implementing the above, I will refer to the book Clear Thinking by Shane Parrish. In this book, he mentions facilitating two separate team meetings: one for defining the problem and another for coming up with solutions. I know I have been in meetings where we immediately want to jump to finding solutions before clearly defining the problem. This could look like having one meeting with your team on (D, E, C, I parts of the DECIDE framework) and then having another meeting to get clear on (D and E).
Since this problem is being reported second-hand by the Communications team, if possible, it would be beneficial to directly interview patients or create a working group with patient family advisors to understand the root of the problem, from the perspective of the patient.
Once you get a clear understanding of the problem, you can then start to identify what type of measures would be beneficial to implement. Since the experience of patients navigating through the healthcare system could be a strong indicator of how well the healthcare system is performing, one could consider choosing an outcome measure.
The use of patient-reported outcome measures (PROMs) in clinical care has been documented to improve quality of life for patients. Several validated assessment tools have been developed based on disease category and patient demographics. Two PROMs that have been used to capture patients’ experiences of their symptoms following hip replacement surgery are the Oxford Hip Score and the EQ-5D-5L assessment tools.
Once we have surveyed our population of interest to determine what the real problem is, we identify alternative solutions, and from this select a specific measure to be tested (could be the Oxford Hip Score, the EQ-5D-5L, or both). The next step is to design an aim statement so everyone is on the same page with the implementation plan.
By clearly defining the measure(s) we will implement, the target we aim to achieve, and when we want to achieve it, the entire team can be clear about the objectives of this analysis.
An example aim statement: We want to implement the Oxford Hip Score within our department and have 75% of our total patient population, within our department, complete this questionnaire by August 2026.
Once everyone is clear about the objective, this can help to combat common issues such as going down side quests and scope creep (to be discussed in a future newsletter).
Finally, we need to evaluate and monitor our solution and refine it if necessary.
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