When implementing any new idea, programme or change within a practice or service, an essential step is putting in place meaningful measures that can be used to monitor progress and impact.
How do you know you're making a difference?
As a team, discuss what success would look like. What measures or changes would you like to see for yourselves and for your patients? Then think about what can you easily measure and choose 2 to 3 measures of change that are meaningful for you as a team.
As stated by the Institute for Healthcare Improvement (IHI), measurement is a critical part of testing and implementing changes in your practice. "Measures, driven by evidence-based guidelines, tell a team whether the changes they are making actually lead to improvement."
There are three types of measures:
- Clinical outcome measures: patient-level disease measures (eg HbA1c, blood pressure, cholesterol levels, weight)
- Process measures: care delivery measures (clinical screenings and other processes that impact clinical outcomes such as cardiovascular risk assessment, mammography and cervical screening)
- Balancing measures: measures to ensure that as the first two types of measures are made, other aspects of the health systems aren’t interrupted (eg patient/provider satisfaction, wait times, cost of care, etc.)
Read more about measures from IHI website & University of Victoria:
- Establishing measures IHI
- Tips for effective measures IHI
- Self-management support measures IHI
- Examples of sample measures IHI
- Measurement of self-management support University of Victoria, British Columbia
Sources of data
The following are potential sources of data and measures you may wish to use.
- Primary Care Team Assessment scores
- Patient experience questionnaire Health Quality & Safety Commission
- Partners in Health scale Flinders University (used in some long-term condition programmes in NZ, Australia and wider)
- Patient Assessment Chronic Illness Care Improving Chronic Care, Group Health
- Number of patients with a documented care plan
- PDSA cycles relating to your team action plan
Decide on a frequency
Once you have identified some useful measures, decide how frequently you will review these. It can be useful to have some short-term measures that are monitored weekly or monthly that provide regular feedback on whether the changes you are putting in place are making a difference. Some measures are best done weekly, others monthly and some 3, 6 or 12 monthly.
Other measures are best done 3, 6 or 12 monthly and give a longer-term view.
Science of improvement: Establishing measures Institute of Healthcare Improvement
Blog: Measurement of improvement or measurement for improvement? Institute of Healthcare Improvement
Patient self-management support programmes: An evaluation Agency for Healthcare Research & Quality