Key Points of Monitoring Progress

Some points recommended by the Institute for Healthcare Improvement:

Measurement should be used to speed improvement up, not slow it down. A team needs just enough measurement to know whether the changes they are making are leading to improvement. This allows them to move forward to the next step. Some things to consider to make measurement simpler and more effective are:

    1. Plot data over time. Improvement requires change and change is, by definition, a temporal phenomenon. Much of the information about a system and how to improve it can be obtained by plotting data-on length of stay, volume, and patient satisfaction-over time, observing trends and other patterns. That is why an annotated time series is the minimum standard for the Breakthrough Series.

    2. Focus on the measure that is directly related to your aim. If the aim is to reduce length of stay in the ED for non-admitted patients, collect data on that measure and plot the data on the annotated time series. Other measures that might be used to operationalize an aim are the time to transfer patients to inpatient beds and the time to thrombolytic treatment. Collecting data on measures such as x-ray turnaround time or time to see a physician, might be helpful to assess components of the system or to assess the results of certain tests but is not required.

    3. Use sampling. Sampling is a simple, efficient way to understand how a system is performing. When large system changes are desired, the variety of conditions included in the sample rather than its size is the primary concern. To save resources, instead of obtaining data for each patient, obtain data for every 20th patient or for patients entering the department at set times during the day (such as at 10 am, 4 pm, 10 pm, and 4 am). These data can be collected daily or on different days during the week and summarized weekly or biweekly.

    4. Integrate measurement into the daily routine. Useful data are often easy to obtain without relying on the information system. Develop a simple data collection form and make collecting the data part of someone's job. The use of sampling will reduce the time burden.

Source: Institute for Healthcare Improvement