A Board's Role in Improving Quality and Safety - Measurement

Resources: Measurement for Improving Quality and Safety

•  Lloyd Provost video with Dr Philip Crowley, National Director, QID   Lloyd’s top tips for the Irish Heath System in measurement for improvement
• Checklist: prioritisation of measures of quality of care
•  Measurement for Improvement Resources
• Anatomy of Statistical Process Control (SPC) Charts

Recommended Reading: Measurement for Improving Quality and Safety

• From Board to Bedside; How the application of Financial structures to Safety and Quality can drive accountability in a large scale organisation; The Joint Commission Journal on Quality and Patient Safety, April 2017.
• From Ward to Board: Identifying good practice in the business of caring; Machell S., Gough, P., Steward K., (2009) From Ward to Board: Identifying good practice in the business of caring. London: The Kings Fund.
• Britain’s Patient-Safety Crisis Holds Lessons for All; Bisognano, M. (2013), Britain’s Patient-Safety Crisis Holds Lessons for All. Harvard Business Review. October 17, 2013.
•  Whole System Measures - IHI Innovation Series white paper; Martin LA., Nelson EC., Lloyd RC., Nolan TW., (2007), IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. 
• Ten Measures of Success for NHS Boards;The Health Foundation (2013)
•  What Non-Executive Directors need to know;NHS Scotland (2016). Quality Improvement and Measurement. The Scottish Government.
•  The run chart; a simple analytical tool for learning from variation in healthcare processes; Perla, R, Provost, L and Murray, S (2011) BMJ Qual Saf 20: 46 – 51
•  Hospital Board Oversight of Quality and Patient Safety, Millar, R, Mannion, R, Freeman, T, and Davies, H. (2013). A Narrative Review and synthesis of Recent Empirical Research’, The Millbank Quarterly, 91 (4): 738-770.
•  The use of quality indicators to promote accountability in health care: the good, the bad, and the ugly; Forster, A and van Walraven, C, (2012). Open Medicine 6(2) e75–e79 

Board Considerations: Measurement for Improving Quality and Safety

• Do we know how good we are? (depends on the availability of organisational data and whether the board and executive review the data to assess performance)
• Do we know where we stand relative to the best? (most healthcare providers look internally at data, but have limited ways of knowing where they stand relative to other organisations, when they see that gap, it’s often very provocative)
• Do we know where our variation exists? (even if a healthcare provider is measuring and reviewing data— both internally and as a benchmark against comparable providers—what good is the data if it doesn’t identify weakness)
• Do we know our rate of improvement over time? (most people think that they’re getting better much more quickly than they actually are, walking through these four questions is often a provocative assessment and does help providers speed up the velocity of improvement in their organisation)