“Without the capacity to measure, we would be uncertain, literally, as to where we stood and where we are going. We would not know if we are rich or poor, hot or cold, old or young. The very word ‘measure’ pervades all fields… You can’t make decisions, connections, money, or music without true measurements.” – Geniat and Libert
In the world of overwhelming data, how do you know if you are measuring the right things? The focus is often on outcome measures. These measures are used to compare performance between organizations and individuals. The struggle is that the outcome measures are often not real-time. It is hard to know whether the improvements you are making have any impact until the end of the month, quarter or year. Good performance measures should focus on systems and processes that create value and are ultimately measured by outcome measures.
For example, the lab I used to manage had the goal of getting lab bills sent out within three days of testing. This was an outcome measure. At the end of every month they could see how they did, but it was too late to change anything and there was no way to explain or learn from variances. We needed to get down to the process level and think about what processes might impact our ability to get billing out in a timely manner.
In this case, we realized that many times we were missing patient information, which caused that bill to fall into work queues and created waste and defects. The team looked at the registration process to reduce the number of registrations that go through with missing data. This is an example of a process measure. We could get this data in real-time every day and make immediate adjustments and improvements to the process.
So, what makes a good performance measure?
They are actionable
It is important that performance measures have practical value, so they can be acted upon.
In the previous example, the measure was the number of registrations with missing data. Each time there was a registration that was missing information the team was able to ask the following questions: what happened in this situation? What can be done differently to prevent this defect?
After answering these questions, the team could adjust, or take action, to improve the process that was used during registration.
Data can be collected in real-time
Real-time data means that the data can be delivered immediately after collection.
Registrations with missing customer information were logged at the time of registration and a worklist collected this information real-time This gave the team the opportunity to identify the cause or reason behind the defect as they were happening. If they needed to wait for a day or week or month for this data, the probability of them being able to pinpoint the reason behind the missing information would have been low.
They are focused
Performance measures also need to be focused. Multiple pieces of any given process are likely impacting the outcome of that process at any given time. The key is to focus on each of the pieces individually to improve the process and what it delivers.
By focusing on each of the common pieces of missing registration data (missing provider, missing diagnosis, etc.), my team was able to focus on the trends in defects to continuously improve the process and reduce defects.
Using these criteria to select good performance measures will help focus improvement efforts and ultimately impact the outcome measures the team is trying to improve.
Linda Mirkes, Network Manager
Improving Performance Measurement workshop
Catalysis Healthcare Value Network