Measurement in Greater Detail

What are we trying to accomplish?

• Idea of cascading measures

• Revisiting our team level dashboards

• Measurement for PDSA cycles

O1

P1

Measure Types

O = Outcome Measure

P = Process Measure

B = Balance Measure

S = Process Step Measure

PDSA = Learning Cycle Measure

O2

P2

B B

P1 P2

S3S2S1

System of Feedback

PDSA1

PDSA2

PDSA3

PDSA4

S3S2S1

PDSA1

PDSA2

PDSA3

PDSA4

© Improvement Science Consulting

O - Mortality

P - ALOS

Measure Types

O = Outcome Measure

P = Process Measure

B = Balance Measure

S = Process Step Measure

PDSA = Learning Cycle Measure

O – Patient Satisfaction B B

P1 P2

S – Time to TheatreS2S1

System of Feedback (Hip Fracture)

PDSA1

PDSA2

PDSA3

PDSA4

S3S2S1

PDSA1

PDSA2

PDSA3

PDSA4

© Improvement Science Consulting

Break out

• Review your team level dashboard

• Are you aimed too high? With too much emphasis on the outcome or process measures of interest?

• If so, what are the steps in your process (Process Map)

• What Process Step Measures could be developed to help you understand performance closer to the frontline of care?

• Do you collect that information currently? How could you collect and use that information at the frontline?

• i.e. CAM tool used reliably on all patients (CAM tooled used/All Admissions to ward 4 reported daily/weekly on a run/control chart)

As the scale of the test increases we move from qualitative to quantitative evidence

Very small scale test of a change idea

Large scale test of change idea or

Implementation of a change idea

Evidence primarily

Qualitative

Evidence primarily Quantitative with

noticeable impact on process measures

Sequence of learning and change

© Improvement Science Consulting

Phases of improvement

• Development - Small scale PDSA level

• Testing under multiple conditions

• Implementation

• Spread

• Could we illustrate relevant measures for a process of interest at every level?

Example 1

(CLAB Insertion Bundle)

Example 2 Example 3

Development Acceptance of drape

Availability of pre-pack

Compliance to individual elements or orprocess

steps (hat use)

Testing Compliance to the bundle (focus on change) undering

varying conditions

CLAB rate on the ward

Implementation Compliance to the bundle (focus on monitoring)

Cost of pre-packs per month

Infection Rate (small multiples by ward and aggregate at facility)

Break out

• Revisit one Change Idea you have for improving care in your process area

• See if you can develop measures that will help you learn about the Change Idea’s operational efficacy (increase degree of belief) starting with a test of change focused at the smallest PDSA level (i.e. 1 patient, 1 nurse, 1 day) and moving through two or three steps to the Process Step Measure Level

• Note: The learning questions and individual PDSA measures should evolve with each cycle, if nothing else than to reflect the increased scale of the cycle

Example 1

(CLAB Insertion Bundle)

Example 2 Example 3

Development Acceptance of drape

Availability of pre-pack

Compliance to individual elements or process steps

(hat use)

Testing Compliance to the bundle (focus on change) under

varying conditions

CLAB rate on the ward

Implementation Compliance to the bundle (focus on monitoring)

Cost of pre-packs per month

Infection Rate (small multiples by ward and aggregate at facility)

Creating dynamic insight into improvement

Outcome Measure(s)

Process Step Measures

Process Measures

Balance Measure(s)

Get Movement

Here by

Hold these

constant or

improve them

Getting

Movement

Here,

Getting

movement here

Get movement here by

Break out

• Revisit the Process Step Measures you identified earlier

• How would your team collect the information identified?

• What would a data collection tool look like for these measures?

• How would you display the information collected for your team? Consider my friend from Ekombe Hospital

• Where would you display your data so it is accessible to your team and other stakeholders on a regular basis?

Creating dynamic insight into improvement

Outcome Measure(s)

Process Step Measures

Process Measures

Balance Measure(s)

What are we trying toaccomplish?

How will we know that a change is an improvement?

What change can we make that will result in improvement?

Model for Improvement

Act Plan

Study Do

Langley, et al.