Understanding measures

Understanding the three types of measures, Process, Outcome and Balancing

Measures are how you quantify and measure the impact of your changes on the system.

They allow you to answer the crucial question: how will we know that a change is an improvement?

They also help you to make predictions of what you expect to happen. This is crucial in healthcare systems where foreseeing negative impact as far as possible is imperative.

You can find and create measures under the 'Measures & Charts' menu option of your project. This page is divided into the three types of measures: process, outcome and balancing (see below.)

The three types of measures

There are three different types of measures: Process, Outcome and Balancing. As these three different types are distinct, it is crucial that you consider all three types to ensure that the changes implemented are sustainable and don't have adverse effects on the system elsewhere.

To help explain, we will use LifeQI's case study of reducing pressure sores by 50% in six months as an example:

Process measures

These are the measures that we take to ensure that the project is running smoothly and effectively. How do we monitor that the data is being collected and that the change is being implemented as planned?

For Life QI's reducing pressure sores case study, process measures would include:

  • Number of staff remembering to get patients out of bed 3x/day
    (number of staff returning fully completed checklists at end of day.)
  • Number of staff remembering to give inpatients pressure sores information (staff return checklist at end of day.)

Outcome measures

These are how we gauge and measure success. How will we know that patient safety and quality have been improved?

In our QI project of reducing pressures sores, two outcome measures would be:

  • Percentage of patients being discharged with pressure sores.
  • Number of patients being treated with pressure sores.

Balancing Measures

Will the changes have potentially negative effects on someone or somewhere else in the system?

To do this we will need to look at the change and the problem we are trying to solve from someone else's point of view.

In our Life QI case study, a negative consequence could be that ward staff, particularly nurses, are struggling to find the time to complete the checklists and to turn patients over three times a day. In turn this may lead staff to feeling pressured to cut corners elsewhere in order to find the time.

As such you could include a measure that checks how staff feel about the change and monitors how many staff turn in their checklists at the end of the day.

  • Percentage of staff handing in daily checklists.
  • Percentage of staff who are happy with the changes on a scale of 1 to 5.