What kinds of measurement problems are common among improvement organizations?

© 2021 Institute for Healthcare Improvement.
IHI Senior Scientist Gareth Parry, MSc, PhD, explains what kinds of measurement problems improvement organizations commonly experience.

Transcript:

In both measurement for quality the control and improvement, one of the big pitfalls is overreacting to one point in time – whether a possible dip, or a possible improvement.
For example, I recall a hospital QI team that got excited about what looked like a big drop in their ventilator acquired pneumonia numbers. It wasn’t until they looked at their data over a longer period of time that they realized they were seeing seasonal variation, rather than an improved system of care.
Having tools and methods readily available to guide people at the point of care on how to understand variation, so we know what is common cause – or essentially random variation, and what is special cause – more indicative of a change in the system is very valuable.
Another problem we often face is when we look at data in the form of rates over time. Say rates of sepsis mortality. Sometimes, when improvement is focused on decreasing sepsis mortality, these efforts can impact on associated processes such as how sepsis is diagnosed, and may lead to patients who, previously were not given a diagnosis of sepsis, now having a diagnosis of sepsis – so that over time, there are increasing numbers of patients with sepsis. Now, if we look at sepsis mortality as a rate, even if the same number of people are dying from sepsis, the increase in the denominator will lead to a reduction in the rate of sepsis mortality. So, we need to be careful when looking at rate data over time, to make sure real improvement is occurring, rather than some unintended artefact.
There are approaches for doing this, that relate to appropriate choice of samples, and data presentation.

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