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Addressing the value of measurement
By Patrice Spath, RHIT
Brown-Spath & Associates
Forest Grove, OR
The subject of health care performance measurement has to date focused on two main topics: What should be measured and how to design efficient measurement systems. The first issue is concerned with making choices about what to measure and how to measure it. The second issue deals with the measurement framework and data collection process. While these two issues are clearly important, it is now time to address the value of measurement. The problem is that performance data are worth nothing unless they are acted upon. People must use the data intelligently to manage and improve performance.
Health care quality professionals must take a leadership role in developing robust measurement systems that add to the knowledge of the organization’s leaders and staff members. New tools and techniques are needed to help people be better managers through measurement.
Insights must be extracted from the data and these insights communicated to those in a position to make changes.
How can quality professionals help ensure measurement influences action and positive results? There are some simple yet powerful techniques for making measurement more valuable.
• Reward improvements, not measurement.
In too many health care organizations, people spend their time justifying why performance is as it is rather than explaining how things are going to improve. Data put people on the defensive. Rather than acknowledge improvement opportunities, managers will use performance reports to explain why everything is just fine. Why is it that in performance reports, people spend most of their time justifying why performance is as it is? They come to the table armed with excuses.
"We are only at 70% of our target because too many of our staff have taken vacations this month." Such discussions, which focus on why performance is as it is, are irrelevant, or at least relatively unimportant in comparison to those discussions that focus on how the department is going to get to where it wants to be. In organizations that reward improvements, not merely measurement, excuses become irrelevant. What matters most is how people are going to achieve ever better performance. The organization’s performance improvement plan should place more emphasis on reporting strategies for improving performance than on reporting actual measurement results.
• Seek answers, not data.
Why do people get drawn into justifying past performance rather than planning for performance improvements? A significant reason is that far too often committee meetings are structured as performance reviews, not planning sessions. It is very common for committee members to simply present raw performance data with an expectation that people will analyze the data on the spot. Nobody in advance of the meeting has been through the data and extracted the messages they contain. People are given mortality rates by service, staff turnover data, and other performance measurement results, and they are expected to make sense of this numerical jigsaw puzzle.
Committee members spend their time trying to draw correlations between differing sets of data to identify unacceptable performance or offer explanations for unusual occurrences.
To change this situation, committee members should define the specific performance questions that they want answered prior to the meetings. Department managers and quality professionals should come to committee meetings armed not with raw data or excuses, but instead with data presentations that address questions of fundamental concern to the committee, e.g., are we going to hit our patient satisfaction targets for this year, how closely are we complying with congestive heart failure guidelines, have our patient falls decreased from the previous year’s rate, etc. The committee’s role then is to probe the quality of the analysis and once the members are comfortable with it, decide what they are going to do to move performance in the desired direction. By changing the focus of performance reports, committees involved in performance evaluations can begin to eliminate the defensive behaviors associated with performance reviews and encourage creative dialogue aimed at performance improvements.
• Build performance analysis capabilities.
Moving to a focus on improvements rather than measurements requires that managers, including quality directors, upgrade their performance analysis skills. As performance analysts, people need to not only to be able to manipulate performance data but also interpret them and present them in a way that engages and provides insight to others.
Think of a performance analyst as a journalist. A journalist not only presents a story, but he or she also very carefully identifies the hook or headline that will capture the reader’s attention and then flush out the detail in the small print. This is how performance reports should be presented. Rarely do people really analyze data before presenting them. Instead, all of their time is spent collecting and collating data.
This issue becomes even more important in a complex organization such as a health care facility. The reality is that performance is the result of multifaceted interdependencies between departments and functions.
Nursing performance relies on materials management as well as other services. Laboratory performance relies on nursing functions as well as transport and other services. Yet when it comes to measurement, these interdependencies are often ignored. Nursing looks at the nursing functions. Laboratory looks at the laboratory functions, etc. It is as if health care organizations have functionalized measurement, just as everything else is functionalized.
• Identify the big picture.
Yet the reality of a health care organization is that the activities being undertaken in different parts interact, and this interaction must be recognized if we are to get the most from performance measurement data.
This is where analysis comes in. Quality professionals, the keepers of performance data from the many different functional areas, are in the best position to identify the bigger picture — the story of what actually is happening within the organization. Prior to committee meetings, quality professionals should sit down with the committee chair and go over the performance data.
Like a journalist, the quality professional should bring up improvement opportunities and inter-relationships with the committee chair. Armed with this information, the chair now can use the performance report at the committee meeting as a starting point for discussing plans for improvements. The agenda item is no longer merely a presentation of a numerical jigsaw puzzle that people rarely have the time to piece together.
To enhance business intelligence, quality professionals must help the organization set up systems to acquire, share, and analyze performance information of all kinds, from the data derived from record reviews to customer satisfaction results.
The ability of an organization to gather and effectively analyze performance information is a major step in the journey toward performance excellence.
A fundamental concept is that of "intelligence," which is different from "information." Intelligence is actionable information — data turned into knowledge that is actually used for something.