This is the first article in a two-part feature on measurement and the Central Measurement Team. Click here to view the second article, Measurement: a look back and a new approach.
Measurement is the cornerstone of improvement. You can't manage what you don't measure. If you don't measure, you can't improve. That has been the mantra of the Central Measurement Team (CMT) since its inception, more than 10 years ago.
According to Dr. G. Ross Baker, lead of the CMT, "Trying to improve without measurement is like trying to sail without a compass." Dr. Baker, along with the dynamic duo of Virginia Flintoft, Project Manager and Alex Titeu, Project Coordinator and Data Analyst has been an invaluable resource to frontline teams in measuring quality improvement initiatives.
Based out of the University of Toronto, the CMT officially opened for business on March 1, 2006 and started to receive data for Safer Healthcare Now! interventions in June that year. Initially, there were six interventions with anywhere from two to 10 measures per intervention. A measurement tool was developed to make it easy to collect and submit data on the initial six interventions. In 2008, four more interventions were added and the work of the CMT has evolved ever since, adding new interventions and extending their work in both topic areas and across healthcare sectors.
The Go-to Resource for Measurement
"Baseline data provides direction," says Flintoft. "Before you implement any change strategies, you need to know if you have a problem or opportunity for improvement. After we launched the measurement tool, we found that measurement was really falling into the lap of frontline staff," says Flintoft. "The frontline staff didn't have the time to do measurement and they didn't have the knowledge. The CMT was a port in the storm for these teams and we still are."
The CMT has relieved a burden for the frontline staff charged with collecting and analyzing data for improvement initiatives. "Patient Safety Metrics was designed to have the teams put in their data and access the reports themselves, without interaction," says Titeu. "However, once the teams started calling us with technical and clinical questions, we formed a lasting relationship with them."
Users know that once their email is received, the CMT will get back to them promptly. The CMT has an unwritten policy that when users called, Virginia or Alex will get back to them within less than 24 hours.
The relationships forged with the CMT are highly regarded and valued by its users. Kristen Parise of Saint Elizabeth Health Care says, "Virginia Flintoft is amazing. She is so easy to work with and is very practical and logical in her progression of questioning. She was so excited about the work we are doing and that helps from our perspective to stay focused on what we need to achieve. She is not that consultant who comes in and gives you all the answers. She wants to impart some of her vast knowledge on you so that at the end of the day, you are better at it the next time. I don't think we would not be as far along on our work with Falls incontinence without her guidance."
Supporting National Audits
To accelerate large scale improvement, the CMT developed quality audit forms for National Audit Months where data was collected for Venous Thromboembolism (VTE), Medication Reconciliation, Hand Hygiene, Falls Prevention and Surgical Site Infection interventions. Participating teams used these forms to collect data and once complete, faxed them to the CMT. Data was populated automatically into the
Patient Safety Metrics system to expedite data collection and reporting.
"The audits reduced the burden of measurement because they were at the patient level and there were multiple indicators collected for each patient in one fell swoop," says Flintoft. "Our users really loved to see how they were doing relative to other organizations, within their regions, with other provinces and across the country. It was competition is a real driver of performance."
"In my mind, the SSI Audit is a nice, tidy parcel with a bow on it," says Samantha Steward, Infection Control Practitioner at the Whitehorse General Hospital. "You are provided with the audit tool to compare with national best practices, it is easy to use, and the data analysis is provided for you. It makes it very easy to get and use the information effectively. If I had to do all of the auditing, data collection, analyzing and reporting, an audit like this would not have been a feasible option."
Safer Healthcare Now! SSI Audit provided a baseline granular view of where we have gaps in data collection and practice," says Wing-Si Luk, Director, Hospital Acquired Conditions Prevention & Management, University Health Network (UHN). "We did not have a robust ongoing mechanism to collect data on the status of practice related to surgical site infection prevention at UHN. The audit was really helpful in terms of providing a snapshot of what we are doing well and where we need to improve. It created a current state for us and an opportunity to compare our data with other healthcare organizations across Canada."
The quality audit tool was also helpful in evaluating if the required steps of the MedRec process had been completed, helping to identify if staff are using more than one source to create the Best Possible Medication History (BPMH). "Using the
Patient Safety Metrics tools and resources enable us to do sample audits, and get our audit results back very quickly," says John Glidden, Horizon Health Network. "Patient Safety Metrics allows us to provide real-time analysis and feedback which helps to keep the momentum going and the enthusiasm up."
"The VTE audit tool available through
Patient Safety Metrics is very straightforward and easy to use," says Chantal Bellerose, Quality Improvement Advisor and Accreditation Coordinator, Jewish General Hospital. "It includes all the relevant measures to audit and benchmark."
Measuring and Monitoring for Safety
With the launch of Shift to Safety, the CMT will no longer support a measurement database. The CMT has taken on more of an expert coach and mentor approach, helping teams to identify opportunities for improvement and supporting their improvement journey, with a focus on measuring and monitoring for safety.