The Measurement Opportunity
Over the past 10 years, more and more of our clients are striving to enhance their ability to measure performance in their organizations. Leaders, board members, funders, teams, and patients all want to know whether key initiatives in our healthcare organizations are making a difference, and whether things are actually getting better for patients and caregivers. As electronic health records and other tools enhance, the hopes for meaningful measurement have grown, but getting there requires some careful thinking.
In the ideal, we want our healthcare organizations to rely on metrics to measure their performance, track progress towards their goals, and make data-driven decisions. However, creating meaningful metrics in healthcare can be both challenging and complex.
If you are familiar with our work, you know we pay very close attention to what we ask people in organizations to focus on. We take great care in designing generative questions to point people towards a desired future rather than amplifying barriers or challenges.
We have the same lens on metrics. Even though our organizations are asked by funders to measure incidents, falls, infection rates and the like, which provide a useful measurement on key safety needs, these may not be meaningful tools for learning, adaptation or continuous improvement. A metric that tracks performance is great for a scorecard, but it is not be as useful for understanding how to make change. In the ideal, we seek measures that help us understand the nuances of what is working, and what might be needed to take the work to the next level.
Our primary interest is in building capacity for innovation and continuous improvement and to give people tools that help along that journey. As such, our approach to measurement is a mix of measuring movement towards goals and outcomes that are meaningful to all stakeholders, and tracking performance in a way that starts to link effort to effect and outcome.
So how do we get to meaningful metrics? Here are a few thoughts.
1) As much as possible, measure desired outcomes not activities – In healthcare, it's important to measure outcomes rather than just activities to truly understand the impact of healthcare interventions on patient health. While activities such as the number of procedures performed or medications prescribed can be useful metrics, they don't necessarily reflect the quality or effectiveness of care provided. Measuring desired outcomes, such as patient health outcomes, ability to participate in life, or quality of life, can provide a more complete picture of the impact of interventions on health.
2) Measure what you want versus what you are trying to avoid - When measuring healthcare outcomes, it's important to focus on what you want to achieve rather than what you are trying to avoid. For example, as our system tries to reduce hospital readmissions, we are tempted to measure the number of readmissions rather than focusing on the underlying causes of readmissions. By measuring what we want to achieve, such as improved care coordination or patient education, we can more effectively address the root causes of readmissions and ultimately achieve better outcomes for patients. Focusing on what you want to achieve rather than what you are trying to avoid can help healthcare organizations identify and address the underlying dynamics that impact patient outcomes, leading to better overall performance and improved patient outcomes.
3) Measure what you can without overburdening your system - As our EHRs improve we have a ton of data to use and mine, but as our health system strains under the pressures of staffing shortages, providers struggle to meet the demands of patient care while also meeting the charting requirements that create robust data sets. In almost every setting, providers talk about the burden of their EHR and the time they spend on evenings and weekends catching up. All of our clients have a great appetite for better metrics but also recognize the need to focus the capture of data to minimize the burden.
Once you have your measures, consider HOW you are tracking performance
We spend a good deal of time with boards as part of our work helping them understand the value of tracking performance in a generative way. This means consciously choosing to measure progress and momentum towards goals, not just their achievement. It means consciously spending time to make meaning of data in ways that inspire creativity and solutions. It means Boards spending time looking beyond the traditional “red, yellow, and green” to explore key insights in each zone:
· Red: What does lack of movement say about what else is happening in the environment? Has something else overtaken this? Where are we seeing any hints of movement? If the original goal hasn’t moved forward, what has? Is this still something that’s important for this overall purpose?
· Yellow: Where are we seeing any hints of movement? If the original goal hasn’t moved forward, what has? What are we learning from this experience? How can we apply that?
· Green: What enabled this green? What does this tell us about what’s important to people? What does it tell us about how to make change happen here? What does it tell us about how to harness what people care about? Where can we link to this commitment and momentum?
The role of leaders and boards is not to get a good scorecard, it is to help an organization to grow and develop in ways that improve care, services and outcomes for the people they serve. Metrics and measurement do tell you how you are doing, but getting a 90% score is not a meaningful outcomes to the stakeholders we serve. As a publicly funded health system, our goal must be to continuously grow, develop and improve so all Canadians have access to the best possible outcomes and quality of life.
