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Building a Measurement System That Works: Milestones, Measure Development, and Sampling


Key Points

  • Without data, you are merely a person with another opinion!

  • Living in concept-land will never produce results!

  • The milestones in the quality measurement journey provide the roadmap for successful results.

Every successful journey starts with a map and a plan. As the milestones along the journey are approached and passed, the traveler has an opportunity to assess progress made toward the journey's destination. Quality improvement (QI) is a journey, but it is a continuous journey that benefits from having milestones that help improvement team members evaluate progress and learn if the initial plan for the journey is leading in the desired direction, toward the expressed results. This chapter addresses a specific segment of the overall QI journey, namely the milestones in the quality measurement journey (QMJ). In this chapter, the first six milestones are discussed: concept, aim, related measures, operational definitions, data collection plan, and data collection ( Fig. 26.1 ). In the next chapter, the analysis and action milestones are covered.

Fig. 26.1
Milestones in the Quality Measurement Journey.

(From Lloyd R. Quality Health Care: A Guide to Developing and Using Indicators . 2nd ed. Jones & Bartlett Learning; 2019:100. Used with permission.)

Moving From Concept-Land to Measurement-Land

All journeys start out as a concept and with thoughts such as, “Let's go and see the Grand Canyon.” This is good, but it is just an aim, a desired outcome. The aim needs to be more concrete. So, the next version is “Let's take a road trip and travel Route 66 to get there!” This is a little more specific, but it is still in the concept phase. What is needed is to move out of concept-land and onto the road. It is only then that this trip can be laid out and evaluated. Measurement strategies and tactics for achieving the aim are required to move out of “concept-land” and into “measurement-land.”

Many healthcare professionals live in concept-land with phrases such as, “We need to…”:

  • ▪

    Reduce wait times

  • ▪

    Improve patient satisfaction

  • ▪

    Reduce waste and inefficiencies

There is nothing inherently wrong with concepts; they provide direction and a vision for what could be. If the concepts are to be realized, however, the measures that these vague notions reflect must be selected and defined to determine the direction implied by the concept. For example, if reducing harm is the concept, how can this be made more specific? Harm is a very broad concept, but if we said that we will reduce harm by reducing the inpatient fall rate (i.e., the number of falls per 1000 inpatient days), then we have moved out of concept-land and into measurement-land.

Identify Potential Measures Related to the Aim

Once members of an improvement team establish a clear and defined aim with a time frame and an idea of the size of the problem (e.g., reduce patient complaints at the surgical clinic by 37% within 3 months; currently the clinic receives about 30 complaints each month), they then must identify potential measures related to this aim. Ideally, the process of identifying potential measures should begin by listening to those who come to the clinic. What does the concept of “complaint” mean to a patient? Are complaints, for example, about scheduling an appointment, lack of friendliness of the front desk staff, time spent in the waiting room, or the communication skills of the doctor? Many factors may be related to reducing complaints and enhancing patient satisfaction.

Once the improvement team has identified several potential measures related to the aim, the number of measures should be reduced into a more manageable set. These are referred to as the vital few measures. One way to do this is to create a family of measures, which consists of three types: outcome, process, and balancing measures ( Box 26.1 ).

Box 26.1
Three Types of Measures

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