WBB's Thought Leadership

Building a Healthcare Quality Measurement Framework

April 17

In order for Healthcare organizations to improve healthcare outcomes, and reduce risks and waste, they must develop, utilize, and manage measurement frameworks that include appropriate process, outcomes, and balancing metrics.

WBB Take:  To be successful and move towards becoming High Reliability Organizations (HRO), healthcare facilities should establish the necessary measurement protocols to develop and evaluate their measurement frameworks, and ensure that metrics remain valid and reliable.
Constructing a measurement framework can be very tasking on an organization; it is therefore advisable to learn from others, research measurement frameworks from successful organizations, and apply their processes. It is important to evaluate internal policies and processes, and to ensure they fit the direction in which the organization needs to move.
The implementation of an effective measurement system analysis (MSA) playbook is also necessary for routine and episodic monitoring of metrics and operational controls to determine their continued accuracy, validity, and reliability.

Cited by Matthew Loxton, Julia Davis, and Stephanie Owusu

Excerpt: “[The] Value-Based Measurement ... approach is ... realistic and effective in reducing risk and waste, and improving outcomes. It involves having a very good idea of what the vision, mission, and objectives are, and being able to map out a value chain of the processes that are key to realizing the organizational goals. Once the key processes are identified, a measurement plan can be developed to probe points along the value chain in order to quantify the associated process, outcomes, and balancing metrics.”

“Process metrics are the leading indicators that will act as unbiased predictors of whether you will reach the objectives at the current achievement rate. Process metrics warn you if something is starting to drift off the road, or can set your mind at ease that things are going according to plan. A good set of process metrics takes much of the guesswork out of managing a process, and reduces risk for all stakeholders. Effective process metrics enable QI and management to detect early signs of variance and error, and take targeted corrective action in good time.”“Outcomes metrics are those that announce whether you have achieved the goals or not, and by what margin you did so. Without valid, reliable, and repeatable outcomes metrics, you simply will not know if you succeeded or not. A big gap in many current measurement frameworks is the lack of patient-centered outcomes measures. Very often, what are claimed to be measures of outcomes are actually rather sloppy proxies for outcomes. Executed surgeries, prescribed medications, and completed encounters, for example, are pseudo-outcomes measures that may not be unbiased predictors of whether the patient is actually better or has achieved their goals. It is therefore important to bulk up on metrics that quantify patient outcomes, rather than rely on doubtful proxies.”

“Balancing metrics are safety guards that alert us when the process is causing risk or harm elsewhere. Effective balancing metrics protect from siloed outcomes metrics, and also monitor for side effects of interventions that may be harming the overall mission. In many cases, achievement in one silo can undermine the capability or capacity of others, and success in one process area is often achieved at the cost of net failure of the overall mission. Without good balancing metrics, there is a risk of doing more harm than good, and not noticing the harm until it is too late. For example, increased successful dialysis episodes is a good outcome, but not if it is displacing successful transplants. A balancing metric that monitored dialysis vs surgery could detect that the unit was harming long-term patient outcomes by emphasizing one to the detriment of more desirable outcomes.”

Source: Physicians Weekly


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