Measurement and feedback are fundamental to quality improvement. There is a knowledge
gap among health care professionals in knowing how to measure the impact of their
quality improvement projects and how to use these data to improve care. This article
presents a pragmatic approach to measurement and feedback for quality improvement
efforts in local health care settings, such as hospitals or clinical practices. The
authors include evidence-based strategies from health care and other industries, augmented
with practical examples from the authors' collective years of experience designing
measurement and feedback strategies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Pediatric ClinicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Crossing the quality chasm: a new health system for the 21st century.National Academy Press, Washington, DC2001
- Improving health care, part 1: the clinical value compass.Jt Comm J Qual Improv. 1996; 22: 243-258
- The three faces of performance measursmement: improvement, accountability and research.Jt Comm J Qual Improv. 1997; 23: 135-147
- A study in hospital efficiency (1917).(Reprinted by the Joint Commission on Accreditation of Healthcare Organizations) Oakbrook Terrace, Illinois1996
- The economic control of quality of manufactured product (1931).Reprinted by ASQC, Milwaukee (WI)1980
- Out of the crisis.Massachusetts Institute of Technology, Cambridge (MA)1986
- An introduction to quality assurance in health care.Oxford University Press, New York2003
- The best practice: how the new quality movement is transforming medicine.Public Affairs, New York2008
- Principles of systems.Productivity Press, Cambridge (MA)1986
- Understanding medical systems.Annals of Internal Medicine. 1998; 128: 293-298
- The new economics for industry, government, and education.2nd edition. Massachusetts Institute of Technology, Cambridge (MA)1994 (p. 92–115)
- The fifth discipline: the art & practice of the learning organization.Doubleday, New York1994
- The improvement guide: a practical approach to enhancing organizational performance.Jossey-Bass Pub, San Francisco (CA)1996
- Deming W.E. Statistical method from the viewpoint of quality control (1939). Dover Press, New York1986: 1-15
- Attributes of core performance measures and associated evaluation criteria.(Available at:) (Accessed November 18, 2008)
- National quality measures clearinghouse.(Available at:)http://www.qualitymeasures.ahrq.gov/(Accessed November 18, 2008)Date: 2008
- The good indicators guide: understanding how to use and choose indicators. NHS Institute for Innovation and Improvement.(Available at:) (Accessed November 18, 2008)
- Continuity of care is associated with well-coordinated care.Ambul Pediatr. 2003; 3: 82-86
- (Available at:)http://www.qualityforum.org/(Accessed November 18, 2008)Date: 2008
- (Available at:)http://www.ihi.org(Accessed November 18, 2008)Date: 2008
- (Available at:)http://www.nichq.org(Accessed November 18, 2008)Date: 2008
- Principles for the development and use of quality measures. Policy statement.Pediatrics. 2008; 121: 411-418
- All-or-none measurement raises the bar on performance.JAMA. 2006; 295: 1168-1170
- Combining multiple indicators of clinical quality: an evaluation of different analytic approaches.Med Care. 2007; 45: 489-496
- Good measurement for good improvement work.Qual Manag Health Care. 2004; 13: 1-16
- How can clinicians measure safety and quality in acute care?.Lancet. 2004; 363: 1061-1067
- Data feedback efforts in quality improvement: lessons learned from US hospitals.Qual Saf Health Care. 2004; 13: 26-31
- Measuring quality improvement in healthcare: a guide to statistical process control application.Quality Press, Wisconsin2001 (p. 43–150)
- The visual display of quantitative information.2nd edition. Graphics Press, Cheshire (CT)2001
- Leaders need dashboards, dashboards need leaders.J Patient Saf. 2006; 2: 45-53
- Educational outreach visits: effects on professional practice and health care outcomes.Cochrane Database Syst Rev. 2007; (CD000409. DOI: 10.1002/14651858)
- Quality health care: a guide to developing and using indicators.Jones & Bartlett Publishers, Boston2004
- Whole system measures. IHI innovation series white paper.Institute for Healthcare Improvement, Cambridge (MA)2007
- How to take multiple measures to get a complete picture of organizational performance.Natl Prod Rev. 1993; 12: 477-490
- Hospital boards and quality dashboards.J Patient Saf. 2006; 2: 10-19
- Getting boards on board: engaging governing boards in quality and safety.Jt Comm J Qual Patient Saf. 2008; 34: 214-220
- Institute for Healthcare Improvement. IHI innovation series. Seven leadership leverage points for organization-level improvement in health care.Institute for Healthcare Improvement, Cambridge (MA)2005
- From the top: getting the board on board. IHI conference: boards, dashboards, and data. Boston.(Available at:) (Accessed November 10, 2008)
- Performance measurement initiatives.(Available at:) (Accessed November 10, 2008)
- Medicare stops paying for 10 reasonably preventable medical errors.(Available at:) (Accessed October 1, 2008)
Glossary
Balanced set of measuresA set of measures which, taken together, reflect as much of a system as possible without duplication, overlap or gaps.
17
BenchmarkAn externally agreed-upon comparator to compare performance between similar organizations or systems.
17
Composite indicatorAn aggregation of numerous indicators that aims to give a one-figure indicator in order to summarize measures further.
Control chartsA graphical tool for displaying the results of statistical process control.
Control limitsDefine the area representing random (also called “common cause”) variation on either side of the centerline, plotted on a control chart.
DashboardA tool used for collecting and reporting data on system-level measures that demonstrate the overall quality of a health system over time. Dashboards provide a quick summary of structural, process and outcome performance.
Plan-Do-Study-Act (PDSA) CycleA quality improvement method consisting of four repetitive steps for learning and improvement. Plan: develop a plan to learn, test, or implement a change; Do: execute the plan; Study: compare predictions to results and document learning; Act: make changes based on learning and set up next cycle. Most changes require several PDSA cycles.
Run chartA time series graph where the X-axis represents time longitudinally and the measure value is on the Y-axis. Run charts often include a median for the data points and can be augmented by inserting comments (annotations) at the point in time where process changes are made by the improvement team or other changes occur that could affect the data (outside of those made by the improvement team, such as a sudden loss of several staff members in a clinic).
Statistical process control (SPC)Statistical analysis and display (eg control charts), which helps distinguish normal, everyday, inevitable variation (“common cause variation”) from nonrandom (“special cause variation”) variation. The latter indicates something special is happening which could be caused by an improvement project or something that warrants a fuller understanding and investigation.
17
Article info
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
