Quality improvement and measurement: what non-executive directors need to know
An overview of quality improvement and measurement for non-executive directors of health boards.
Appendix 2a - The three reasons for measurement
Data and its measurement for improvement are used differently from data employed for judgement or for research. It is vital that Board members know the difference between these and the expectations on Board members for each type of measurement. In this video Mike Davidge explains how measurement for improvement is different to traditional measurements used in healthcare.
Characteristic |
Judgement |
Research |
Improvement |
---|---|---|---|
Aim |
Achievement of target |
New knowledge |
Improvement of service |
Testing strategy |
No tests |
One large test |
Sequential tests |
Sample size |
Obtain 100% of available, relevant data e.g. percent of patients who have been seen within a predetermined waiting time |
'Just in case' data e.g. systematic analysis of an outpatients' invitation to attend notes to test the effectiveness of a new IT system |
'Just enough data', small sequential samples e.g. five case notes from yesterday - followed by five today to see if staff are actually undertaking and recording all three elements of a care bundle |
Type of hypothesis |
No hypothesis |
Fixed hypothesis |
Hypothesis flexible, changes as learning takes place |
Variation (bias) |
Adjust measures to reduce variation |
Designed to eliminate unwanted variation |
Accept consistent (random) variation |
Determining if a change is an improvement |
No change focus |
Statistical tests, p-values |
Run charts or Shewhart control charts |
Adapted from: The Three Faces of Performance Measurement: Improvement, Accountability and Research. Solberg, Leif I., Mosser, Gordon and McDonald, Susan Journal on Quality Improvement. March 1997, Vol.23, No. 3.
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