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Measurement

Principles

Boards need access to relevant and informative measures of safety and quality that they can use to assess current performance and target improvement strategies.

Board-Level Performance Measurement

  • System-level measures can enable boards to benchmark organizations against each other and to monitor progress over time.
  •  Indicators can measure the quality of different aspects of care delivery. The Ontario Health Quality Council annual report provides indicators for various sectors of the healthcare system, including:
    • Acute care (Waiting times for specialized procedures and surgeries)
    • Long-term care (Prevalence of falls, pressure ulcers and infections in LTC)
    • Community and home care (Percentage of clients receiving home care visit following referral to community care access centres)
    • Primary care (Access to primary care physicians)
    • Regional health (Risk factors and healthy behaviors for Ontarians – smoking rates, exercise, obesity, alcohol consumption)
  • Measures that are relevant to the board should answer the basic question of “Is our care getting better”, and consider if the measures do not answer such questions, it is worthwhile to consider whether current performance measurement strategies are effective.
    • Powerful measures for boards can include raw local hospital data on key counts, such as deaths, surgical complications, infections, patient complaints and patient satisfaction.

Reporting Practices for Quality and Patient Safety

Effective practices of measuring quality and safety include:

  • Developing a dashboard with limited numbers of measures reflecting strategic goals
  • Incorporating real time measures of clinical performance
  • Developing composite measures that “roll up” related indicators for the board

Evidence from the UK demonstrates that NHS Trusts which report high levels of safety incidents suggest a stronger organizational culture of safety because they take all incidents seriously and link reporting with learning. Strong and visible leadership from boards can be enabled through investment in reporting, investigation and analysis of adverse events and by using this incident data to support decision making at a board level.

The National Patient Safety Agency (UK) suggests five actions to improve safety reporting including:

  1. Give feedback to staff
  2. Focus on front line staff
  3. Engage front line staff
  4. Make it easy to report
  5. Make reporting matter

Briefing:  Act on Reporting, Five Actions to Improve Patient Safety Reporting, June 2008;

Organizational reports of critical incidents/serious reportable adverse events can be reviewed by the board on an annual basis, including a summary of corrective actions and an update on corrective actions from the last annual review.