1. Measurement in Greater Detail

2. What are we trying to accomplish?
Idea of cascading measures
Revisiting our team level dashboards
Measurement for PDSA cycles

3. O1 P1 O2 P2 B S3 S2 S1 System of Feedback Measure Types
O = Outcome Measure
P = Process Measure
B = Balance Measure
S = Process Step Measure
PDSA = Learning Cycle Measure O2 P2 B S3 S2 S1
System of Feedback
PDSA1
PDSA2
PDSA3
PDSA4
© Improvement Science Consulting

4. O – Patient Satisfaction B
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 P1 P2
S – Time to Theatre S2 S1
System of Feedback (Hip Fracture)
PDSA1
PDSA2
PDSA3
PDSA4 S3
© Improvement Science Consulting

5. 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)

7. 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

8. 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?

9. (CLAB Insertion Bundle)
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)

10. 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

11. (CLAB Insertion Bundle)
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)

12. Creating dynamic insight into improvement
Outcome Measure(s)
Process Measures
Getting Movement Here,
Get Movement Here by
Get movement here by
Balance Measure(s)
Process Step Measures
Hold these constant or improve them
Getting movement here

13. 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?

14. Creating dynamic insight into improvement
Outcome Measure(s)
Process Measures
Balance Measure(s)
Process Step Measures

15. Model for Improvement Act Plan Study Do What are we trying to
accomplish?
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.