This is the second article in a two-part feature on measurement and the Central Measurement Team. Click here to view the first article, Measuring for safety: The evolving role of the Central Measurement Team
A look back on Patient Safety Metrics
The initial measurement tool used for Safer Healthcare Now! data submission was developed over a decade ago, using Excel spreadsheets. By 2009, it became obvious that an online tool was needed. A web-based tool was developed as a data submission and reporting system that provided teams with the ability to aggregate and disaggregate results to report by region, facility or individual patient samples by team. The Excel spreadsheets were phased out with the launch of Patient Safety Metrics in January 2011.
Patient Safety Metrics allowed organizations to track and report on over 100 key process measures aligned with the Safer Healthcare Now! interventions. Numerous National Calls were conducted to provide users with training on how to measure, what to measure and how to use the Patient Safety Metrics tools.
Stephanie Howse, a Clinical Coordinator with Alberta Health was new to her position when one of her colleagues suggested that she use Patient Safety Metrics to monitor medication reconciliation compliance across the Northern Lights Health Region. Stephanie was surprised to find how intuitive and user-friendly the tool was. "Patient Safety Metrics provides a bird's eye view of how we are doing," says Stephanie. "You can drill down and identify trends with the data. There are self-study modules available on how to interpret the data and the Central Measurement Team is always available to troubleshoot and help you to better understand the findings."
"The Patient Safety Metrics tool is easy to use and provides the right reports that allows you to do the comparisons that you need to do," says Dr. Elizabeth MacKay, Medical Leader, Provincial VTE Prophylaxis Accreditation Working Group, Alberta Health Services. "The ability to compare your results to national groups provides information that is invaluable."
Virginia Flintoft says that aside from all of its benefits, there was one small flaw of the Patient Safety Metrics system. It was designed for teams to directly access their reports; however, most often the teams would call the Central Measurement Team to run the reports for them. "The ownership wasn't there; most often they were just too busy," says Virginia Flintoft, Project Manager, Central Measurement Team (CMT).
"What we found with Patient Safety Metrics is that the people entering the data were not the ones looking at the results and accessing the reports," says Alex Titeu, Project Coordinator, CMT. "The goal behind Patient Safety Metrics was for the individual entering the data to see their results right away."
Patient safety and quality improvement has evolved immensely over the years and so too has the CMT. "It is definitely time that organizations manage and monitor their own data," says Virginia Flintoft. "Most hospitals now have the talent inhouse and the resources."
The data collection segment of Patient Safety Metrics was phased out this spring. The CMT has permission to hold the data and all records will continue to be held in a secure location for up to seven years. Data has been sent back to participating healthcare organizations, who the owners of the data. Over half of the data has since been repopulated. The CMT has been communicating with the remaining participating organization's CEO to ensure they have downloaded their data, or to indicate where it is to be sent to.
A new approach to solutions that stick
With the unveiling of Shift to Safety, the role of the CMT will also transition to more of an expert coach and mentor approach that leverages the most up-to-date thinking related to the measurement and monitoring of patient safety. "The CMT will no longer support a measurement database," says Virginia Flintoft. "The approach now will be to get the teams to identify the opportunities for improvement and the CMT will coach and mentor them through their improvement journey, focusing on measuring and monitoring for safety."
Under the guidance of Dr. G. Ross Baker and Dr. Charles Vincent (Oxford University, UK), a comprehensive measurement program is being developed based on Vincent's framework for Measurement and Monitoring Safety. The framework specifies five elements required for safety measurement and monitoring: past harm, reliability, sensitivity to operations, anticipating and preparedness, and integration and learning. The measurement platform will focus on guiding leaders, practitioners, patients, families and informal caregivers to find local and system level answers to how they can prevent harm, respond to harm and learn from harm through the application of the framework.
"The beauty of the new framework is that it doesn't matter what your problem is," says Virginia Flintoft. "The framework teaches you how to find the solution to the problem; solutions that stick. It is very exciting as it will save teams time and help them to think bigger. It is learning about meaningful change that is clinically significant. Teams may see statistically significant change, but clinically significant change is really the crux of measurement."
Improvement in the future will always include measurement and the CMT will continue to work with frontline staff on the wards, right up to Boards to help them monitor their performance.