How To Measure Quality Improvement In Healthcare (2022)

What’s the most important measure in healthcare? Speed is interesting and needed for urgent care, but not all healthcare is urgent. Cost is important as well, but varies widely and involves many complex factors. Quality—otherwise known as getting it right the first time—is the most important measure in healthcare because it directly influences speed, cost, and everything in between. Whether it’s patient lengths of stay and rates of readmission or hospital costs for additional treatments and system process errors, quality is the determining factor.

Once you accept it’s the most important measure, defining quality and figuring out how to measure it within your organization is the next challenge. Medicare has begun to offer guidance by introducing a hospital value-based purchasing program. The program assesses the clinical process, patient experience, outcomes, and efficiency of the hospital. In short, Medicare has started to define quality measures for reimbursement rates. But you’ll want to implement measures for more reasons than reimbursement rates. In this article, we’ll walk you through quality improvement principles, as well as best practices for developing healthcare measures for quality in your organization.

Principles Of Quality Improvement In Healthcare

Because healthcare is so personalized to the patient, it’s sometimes considered hard to apply quality improvement processes. And yet more and more hospitals are proving that theory wrong. Healthcare systems and processes can coexist with personalized care—the organization’s “back-end” operations can impact the individual patient’s well-being to an extent that quality improvement measures can be implemented.

Because healthcare is so personalized to the patient, it’s sometimes considered hard to apply quality improvement processes. And yet more and more hospitals are proving that theory wrong. Click To Tweet

As introduced by Health Catalyst, there are five guiding principles that healthcare organizations can use to successfully implement quality improvement initiatives:

(Video) Quality Improvement in Healthcare

Principle 1: Promote hands-on improvement projects.

High-level strategy discussions and ideas aren’t enough to promote quality improvement in healthcare. Hands-on work aids the adoption of quality improvement projects because staff and physicians can see the direct impact in real-life situations. It also incentivizes internal teams when the organization identifies an area that needs improvement, and encourages staff and physicians to play an active part in the strategy.

Principle 2: Get buy-in on what “quality” means.

Part of the difficulty in defining quality improvement stems from the word “quality” itself. It’s subjective, and organizations sometimes suffer from internal clashes on how to characterize those seven letters. It’s important to get buy-in across the organization on exactly what quality means so you can objectively determine if it’s improving. However you decide to define quality, it should be measurable and revolve around patients. Healthcare organizations are guided by a mission to improve the lives of patients, so your definition of quality should overlap with how you care for them.

Principle 3: Focus measures on improvement vs. accountability.

Since quality improvement in healthcare revolves around the patient, performance measures should focus on improvement rather than accountability. When accountability is overemphasized, the needs of the patient are superseded and quality improvement can’t be applied. For example, a typical accountability measure might collect data on the percentage of ER patients who waited more than 30 minutes, and hold management accountable for keeping wait times under 30 minutes. A better tactic would focus on the system and collect actual wait time data in minutes to measure performance, instead of just focusing on the person who’s held accountable for those wait times. By taking this approach, a process can be improved.

Principle 4: Use an established quality improvement framework.

There are plenty of quality improvement frameworks to choose from, but the most successful take an iterative, methodical approach rather than making sweeping changes all at once. Here are two popular framework examples:

Six Sigma DMAIC Model

(Video) Intro to Quality Improvement in Healthcare

The DMAIC model is used for Six Sigma projects, but is also a general framework healthcare organizations can apply to quality improvement projects. The data-driven strategy takes a cyclical approach to optimizing and stabilizing processes. It includes five phases that form its acronym:

  • Define: Outline the problem.
  • Measure: Quantify the problem.
  • Analyze: Identify the cause of the problem.
  • Improve: Implement and verify the solution.
  • Control: Maintain the solution.

Six Sigma DMAIC can be implemented as a standalone quality improvement project or as part of larger healthcare quality management initiatives.

Model for Improvement

The Model for Improvement was developed by the Associates in Process Improvement. Tongue-twisting names aside, this is one of the most commonly used quality improvement frameworks in healthcare. It asks three fundamental questions:

  • What are we trying to accomplish?
  • How will we know that a change is an improvement?
  • What changes can we make that will result in improvement?

To answer these questions, an organization creates goals, aims (subsets of goals), and interventions (changes to the system or process). Interventions specifically address the third fundamental question above and follow a PDSA (plan, do, study, act) cycle, which tests changes to see their effect on outcomes. The Model for Improvement is successful because changes are always incremental—they start small, are tested, applied more broadly, tested again, and then implemented. And, as with the DMAIC, it’s an iterative process. The quality improvement framework repeats itself to ensure reliability of results and continual improvement efforts.

(Video) Measurement for quality improvement

Principle 5: Understand intended and unintended data variation.

When making changes to processes or systems, there will be both intended and unintended results. Strong healthcare business management involves being able to recognize and understand these two types of data variation. Intended variation is purposeful change, whereas unintended variation is accidental change, which can sometimes impede your long-term quality improvement goals.

Realize from the outset that unintended variation is inevitable and naturally occurring. It’s impossible to control every result when making changes in your organization. If you have an unintended variation that doesn't align well with your overall goal, adjust that goal or create a new goal entirely.

This is also why the iterative frameworks mentioned in Principle 4 are so important—making small, phased manipulations in a repetitive manner allows you to more accurately measure the data and understand what change (intentional or unintentional) caused a certain result.

Best Practices For Measuring Quality Improvement In Healthcare

The specifics of how you weigh and measure quality improvement will vary, but these best practices are foundational:

Integrate quality improvement into your organization’s daily life.

Your quality improvement efforts should be fully integrated into your healthcare processes and procedures. If quality improvement is an afterthought, or seen as a divergent effort within the organization, it won’t be successful. Get everyone on board—quality must be an accepted and embraced part of your internal culture. You can create this culture of providing the best service to patients by forming quality improvement teams, holding regular quality improvement meetings, publishing goals and results, and more.

(Video) The Six Dimensions of Healthcare Quality

Identify potential areas for improvement.

A healthcare organization is a complex machine and it’s not easy to determine and prioritize areas that could be improved. What does your patient population data tell you? Where are stumbling blocks in your current operations? Several national forums can guide you in the process for identifying areas to apply quality improvement, such as the Agency for Healthcare Research and Quality. This federal agency outlines three types of quality measures:

  • Structural measures: The healthcare organization’s capacity, systems, and processes, such as number of physicians, types of technology, and physician-to-patient ratios.
  • Process measures: What is done to maintain or improve health, like percentage of people who received preventive services and length of patient wait time.
  • Outcome measures: The impact of healthcare services, such as results of care. (Risk adjustments are typically included to account for factors out of the hospital’s control.)

Collect and analyze data.

Data is the only objective way to prove whether your quality improvement efforts have been successful. It’s critical to have a team that collects data and tracks it against quality improvement measures and goals. Most importantly, the team will analyze and interpret the metrics so your healthcare organization can make better, data-backed decisions. This is a long-term commitment—data should be collected and analyzed prior to a project to set a baseline, during the project, and on-going after a project ends to assess lasting results.

Are you collecting the right data? Here are 108 healthcare KPIs and measures you might want to track.

Involve teams and share results.

Transparency is key to quality improvement in healthcare organizations. Include your staff, physicians, and even patients in the planning and implementing phases of quality improvement projects; then, share the results of your efforts with everyone. Also share your results with other healthcare organizations. Open communication will shorten your path to improvement and establish your facility as a leader in the industry.

Plan on continuous evaluation.

Quality improvement never ends. The best healthcare organizations have embedded quality into their culture and continually strive to improve their performance and patient care. This includes implementing new improvement processes and revisiting previous processes to ensure they are still helping your organization move forward. Plan to dedicate resources to this process on an ongoing basis.

An Example Of Quality Improvement In Healthcare

In 2011, the Cincinnati Children’s Hospital Medical Center was struggling with patient flow. Unnecessarily long patient stays, unpredictable discharges, and process delays were raising costs for both the hospital and patients. To address these challenges, the hospital’s quality improvement team developed standard discharge criteria for 11 common inpatient diagnoses and embedded these criteria in electronic medical records. Nurses could more easily track when patients hit discharge goals, doctors could better prioritize patients, prescriptions were filled faster, and overall discharge processes were smoother and tailored to patients’ needs.

(Video) A quick guide to successful Quality Improvement

By 2014, 80 percent of eligible patients were discharged within two hours of meeting the established criteria. More efficient discharges led to shorter lengths of stay and more beds for higher acuity patients. This resulted in an estimated $5.9 million in cost savings to the hospital and families.

This is just one example of how quality improvements can make a dramatic impact on patient lives and produce substantial savings. When implemented in an effective framework and measured properly, quality improvement initiatives can change the way your hospital works, from internal culture to patient care.

How To Measure Quality Improvement In Healthcare (1)

FAQs

What are the five key measurements of quality improvement? ›

5 Key Components of Quality Improvement Programs
  • The problem,
  • The goal,
  • The aim,
  • The measures, and.
  • The Analytics.
Dec 11, 2019

What are the 3 types of measures for quality improvement? ›

Three Types of Measures

Use a balanced set of measures for all improvement efforts: outcomes measures, process measures, and balancing measures.

How do you determine quality improvement? ›

  1. Determine and prioritize potential areas for improvement. You will need to identify and understand the ways in which your practice could improve. ...
  2. Collect and analyze data. Data collection and analysis lie at the heart of quality improvement. ...
  3. Communicate your results. ...
  4. Commit to ongoing evaluation. ...
  5. Spread your successes.

How are quality outcomes measured in healthcare? ›

Outcome measures reflect the impact of the health care service or intervention on the health status of patients. For example: The percentage of patients who died as a result of surgery (surgical mortality rates). The rate of surgical complications or hospital-acquired infections.

What are examples of quality improvement in healthcare? ›

What are Examples of Quality Improvement Initiatives in Healthcare?
  • Reduction in medication-related adverse events.
  • Optimization of sepsis care.
  • Decreased number of urinary catheter infections.
  • Reduced hospital readmissions.
  • Decreased medication administration errors.
  • Improved electronic medical record documentation.
Jan 28, 2022

What are 5 factors that identify quality healthcare? ›

He identified 182 attributes of quality healthcare and grouped them into five categories: environment, empathy, efficiency, effectiveness and efficacy.

What are four main principles of quality improvement? ›

In addition to focusing on the patient-centered dimension of care, quality improvement efforts also focus on safety, effectiveness, efficiency, and timeliness.

How do you measure quality standards? ›

Consider this list of steps you can use to measure quality:
  1. Decide what factor to measure. ...
  2. Determine the method of measurement. ...
  3. Establish quality assurance procedures. ...
  4. Create and standardize policies for future quality measurement activities. ...
  5. Revisit quality standards periodically.
Nov 2, 2021

What is a process measure in quality improvement? ›

Process measures are the “voice of the workings of the system.” In other. words, process measurements are those that capture the changes your. quality improvement efforts make to the inputs or steps that contribute to. system outcomes.

What is a quality improvement metric? ›

Quality metrics are measures that the Centers for Medicare and Medicaid Services (CMS) and other regulatory agencies use to assess the clinical performance, care quality, and safety measures of all healthcare providers. These metrics can be classified in three ways: Structural measures. Process measures. Outcome ...

What are the 6 aims of healthcare improvement? ›

Its follow-up report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001), introduced the IOM Six Aims for Improvement: care that is safe, timely, effective, efficient, equitable and patient-centered (STEEEP).

How do you measure performance in healthcare? ›

She suggests ten essential healthcare performance measures:
  1. Length of stay. ...
  2. Readmission rates. ...
  3. HCAHPS – patient satisfaction. ...
  4. Mortality rates. ...
  5. Bed utilization rate (or bed occupation rate) ...
  6. Hospital incidents. ...
  7. CMS program performance initiatives. ...
  8. Average cost per discharge.

How do you measure efficiency in healthcare? ›

Generally, efficiency assessment can be done by various methods including ratio analysis, least-squares regression (LSR), total factor productivity (TFP), stochastic frontier analysis (SFA), and Envelopment Analysis (DEA) (8-10).

What are quality performance measures? ›

Quality performance measures seek to measure the degree to which evidence-based treatment guidelines are followed, where indicated, and assess the results of care. The use of quality measurement helps strengthen accountability and support performance improvement initiatives at numerous levels.

What are quality measures in healthcare? ›

Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.

What is a quality improvement plan in healthcare? ›

The purpose of the Quality Improvement (QI) Plan is to provide a formal ongoing process by which the organization and stakeholders utilize objective measures to monitor and evaluate the quality of services, both clinical and operational, provided to the patients.

What are the key elements of a quality improvement initiative? ›

All successful quality improvement programs include four key components: the problem, goal, aim, and measures. All successful quality improvement programs start with an in-depth understanding of the problem.

What are the 6 dimensions of quality in healthcare? ›

Don Berwick describes six dimensions of quality in health care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Which of the following is the best measure for the quality of care? ›

The absolute measure of the quality of care is patients outcomes (cure rate, complications, survival rate, length of stay, treatment received, readmission, patients' satisfaction, ..).

What are the 3 components of quality health care? ›

Effective – providing evidence-based healthcare services to those who need them; Safe – avoiding harm to people for whom the care is intended; and. People-centred – providing care that responds to individual preferences, needs and values.

What is the most important step in quality improvement? ›

Plan: Analyze the process, determine what changes would most improve the process, and establish a plan for making the improvement; Do: Put your change into motion on a small scale or trial basis; Study: Check to see whether the change is working; Act: If the change is working, implement it on a larger scale.

What are the 4 steps in the quality improvement cycle? ›

There are 4 basic steps in PDCA Cycle:
  1. Plan: identify a problem and possible solutions.
  2. Do: execute the plan and test the solution(s)
  3. Check: evaluate the results and lessons learned.
  4. Act: improve the plan/process for better solutions.
Jan 28, 2021

How do you ensure continuous quality improvement? ›

Best Practices for CQI
  1. Ensure that you have the correct data to address the chosen problem. ...
  2. Measure more than the outcome. ...
  3. Aggregate data so you and the teams that follow you can understand patterns of input and results.
  4. Review data collection tools and process for relevance.
Oct 26, 2017

How do you measure quality assurance effectiveness? ›

You can determine the efficiency of a QA team by measuring how long, on average, it takes to execute each test in a given cycle. These times should decrease after initial testing and eventually plateau at a base level. QA teams can improve these numbers by looking at what tests can be run concurrently or automated.

How do you measure the success of quality assurance practice? ›

Top 5 Criteria for Measuring QA Team Success
  1. Bug Acceptance Rate. This is a great barometer to track QA team reporting. ...
  2. Qualitative Bugs. It is not always about the quantity of bugs; however, it is primarily about the quality (important and critical) of bugs. ...
  3. Task Productivity. ...
  4. Task Accuracy. ...
  5. Fix Failed Bugs.

What methods can be used to measure the achievement of quality standards? ›

Quality Assessment
  • Observation of service delivery (by expert observers, peers, supervisors)
  • Mystery client method.
  • Audit of individual patient records.
  • Review of data from automated information system.
  • Testing (written tests, simulation with standardized patients, computer-based testing)
  • Health worker interview.

What are the different types of quality measures? ›

There are different types of quality measures, and they are usually categorized into four categories: process, outcome, structural, and balancing measures.

How do you measure process measures? ›

The most common type of process measure is a counting system that keeps track of how much of something is being administered. For example, if an organization attempts to increase school engagement by doing school visits, recording the number of school visits can be one measure of program delivery.

What are the four measures of health? ›

The 4 summary mortality and health measures are:
  • OHM-5: Life expectancy at birth.
  • OHM-6: Free of activity limitation.
  • OHM-7: Free of disability.
  • OHM-8: Respondent-assessed health status — in good or better health.

What are the six priorities for high quality care? ›

A set of six quality priorities for fast-tracking improvement have been identified, these include safety and security, long waiting times, drug availability, nursing attitude, infection prevention and control and values of staff.

How do you measure patient centered care? ›

Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so.

Why is quality healthcare important? ›

It's because processes for delivering care have broken down, triggering adverse events and poor patient outcomes. Quality matters because lives are at stake. We are fully capable of doing better once processes associated with positive outcomes are in place.

What is a process measure in quality improvement? ›

Process measures are the “voice of the workings of the system.” In other. words, process measurements are those that capture the changes your. quality improvement efforts make to the inputs or steps that contribute to. system outcomes.

How do you measure performance in healthcare? ›

She suggests ten essential healthcare performance measures:
  1. Length of stay. ...
  2. Readmission rates. ...
  3. HCAHPS – patient satisfaction. ...
  4. Mortality rates. ...
  5. Bed utilization rate (or bed occupation rate) ...
  6. Hospital incidents. ...
  7. CMS program performance initiatives. ...
  8. Average cost per discharge.

What is a quality improvement metric? ›

Quality metrics are measures that the Centers for Medicare and Medicaid Services (CMS) and other regulatory agencies use to assess the clinical performance, care quality, and safety measures of all healthcare providers. These metrics can be classified in three ways: Structural measures. Process measures. Outcome ...

What are quality performance indicators in healthcare? ›

Quality Indicators (QIs) are standardized, evidence-based measures of health care quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes.

How do you measure quality? ›

Businesses can measure quality aspects such as:
  1. Failure or reject rates.
  2. Level of product returns.
  3. Customer complaints.
  4. Customer satisfaction – usually measured by a survey.
  5. Customer loyalty – evident from repeat purchases, or renewal rates.
Mar 22, 2021

What are the different types of quality measures? ›

There are different types of quality measures, and they are usually categorized into four categories: process, outcome, structural, and balancing measures.

What does quality measurement require? ›

A quality measurement tool must: Be objective. Be based on scientific evidence. Not affect or distort results.

What are the 5 key performance indicators in healthcare? ›

Five key performance indicators for healthcare organizations: People, quality, time, growth & financial performance.

How is quality measured in a hospital? ›

The principal methods of measuring hospital performance are regulatory inspection, public satisfaction surveys, third-party assessment, and statistical indicators, most of which have never been tested rigorously.

What are the four measures of health? ›

The 4 summary mortality and health measures are:
  • OHM-5: Life expectancy at birth.
  • OHM-6: Free of activity limitation.
  • OHM-7: Free of disability.
  • OHM-8: Respondent-assessed health status — in good or better health.

What is quality measurement system? ›

MSA evaluates the method, instruments, and the entire process of obtaining measurements to ensure the integrity of data used for analysis, usually quality analysis. MSA is an important element of Six Sigma methodology and of other quality management systems.

How are healthcare KPIS measured? ›

The KPI can be either measured in terms of an individual treatment fee or in the form of an average treatment fee taken from all the patients during a certain amount of time. The average treatment charge is a good measure of business objectives relating to reducing hospital costs.

What are examples of performance measures? ›

Productivity, profit margin, scope and cost are some examples of performance metrics that a business can track to determine if target objectives and goals are being met. There are different areas of a business, and each area will have its own key performance metrics.

What are three key aspects of quality healthcare? ›

Effective – providing evidence-based healthcare services to those who need them; Safe – avoiding harm to people for whom the care is intended; and. People-centred – providing care that responds to individual preferences, needs and values.

Videos

1. Measurement for Quality Improvement – Understanding how to use the Data
(Royal College of General Practitioners)
2. How to Measure and improve healthcare quality | MeasureDev 2021
(Center for Effective Global Action)
3. Integrating Continuous Quality Improvement in Nursing and Healthcare
(Jones & Bartlett Learning)
4. How do you spread quality improvement?
(Institute for Healthcare Improvement - IHI)
5. QI Basics: Model for Improvement PDSA
(Stratis Health)
6. Module 1 – Introduction to Measurement in Primary Care Quality Improvement
(University of Toronto Family & Community Medicine)

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