What Are Measures What Makes Measures Good and How Do They Relate to Aims

In general you can think of measures (or variables) as things to be counted so you can evaluate the amount (or the status) of a thing of interest. People in clinical microsystems use many different types of measures to evaluate such interesting and important things as quality, safety, costs, satisfaction, productivity, reliability, and so forth.

Good measures have several important characteristics.

• Good measures can provide an answer to a critical question. For example, an emergency department might ask, "Have we reached our specific aim of doing an ECG and drawing cardiac enzymes on every appropriate patient within fifteen minutes of arrival?" and the appropriate measures would answer that question.

FIGURE 22.1. IMPROVEMENT RAMP: MEASUREMENT.

Success Measure

You Are Here

Action plans Gantt charts Chapter 23

Success Measure

©Chapter 14

Cause and effect diagrams Chapter 19

Process mapping flowcharts

Chapter 17

Meeting skills Parts 1 & 2 Chapters 12 & 20

You Are Here

Action plans Gantt charts Chapter 23

Cause and effect diagrams Chapter 19

Process mapping flowcharts

Chapter 17

Meeting skills Parts 1 & 2 Chapters 12 & 20

Chapter 13

• Good measures are sufficiently accurate (reliable and valid) for the purpose at hand, such as having your own local, relevant evidence on your microsystem's level of performance.

• Good measures have such basic working parts as

A descriptive name

A conceptual definition describing the measure

An operational definition describing the method to be used to score or categorize the measure

Graphical (or tabular) data displays that can be used to answer the critical question

It takes good measures to determine whether your global aim and specific aims are being met.

Recall that the basic model for improvement begins with three questions (see Chapter Fourteen).

1. Aim. What are we trying to accomplish?

2. Measures. How will we know that a change is an improvement?

3. Changes. What changes can we make that will result in an improvement?

Look again at the improvement ramp, and you will see how all of this fits together—aims, measures, use of the scientific method in the form of PDSA to make changes to reach a targeted level of performance, and use of SDSA to maintain the needed level of performance.

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