I have had a few conversations recently (often with senior people in our organisation) about the need to measure and use data in order make changes that lead to improvements. At a quality improvement (QI) teaching session today, we also discussed this at length and I thought it would be useful to share my own experience and see if people agree.
The two basic questions I was faced with recently were:
1 – Do we need to study data every time we are making a change for improvement, or can we just make a change because we instinctively know it is the right thing to do? and…
2 –If we make a change that leads to an improvement and we haven’t measured it, have we really made an improvement?
(This second question is much like the philosophical question ‘if a tree falls in a forest and no one is around to hear it, does it make a sound?’ and it is probably best not to get into such questions here!)
Why measure for improvement?
Only in rare cases are the changes that we make clear, obvious and binary choices – where no data is required to either inform the changes or understand if we have made an improvement. For example, if we work somewhere with a leak in the ceiling we don’t need data to know a) we should fix the ceiling and b) things will be better once the ceiling is fixed!
But how often do we discuss improvements that are so simple? We work in complex systems where making changes that lead to improvement often requires testing and adapting.
Most changes we make will involve people and complex processes. There will rarely be obvious answers and we will be faced with many possible options for change. In these cases we should always be using data to inform our improvement activities.
Keep it simple
Having made the case that using data and measurement is vital for QI, it is important to note that measuring for improvement should not be difficult to do and we should do everything we can to keep it simple.
Measuring for improvement requires using a few specific measures, linked to our objectives and aims, to test and then demonstrate whether the changes are making improvements.
It is important to remember that, when we are setting out to collect data, we are seeking usefulness, not perfection.
Our goal is improvement, not the development of a measurement system. We should resist the temptation to wait days or weeks to receive data from our information systems if it is not essential and instead we should try to use simple data collection systems and a few simple measures.
We can then use this to understand our current performance, develop ideas and test changes to see if they lead to improvement; and also ensure that improvements are being sustained in the long-term.
Plotting your data over time and making it visible is also a great way to get people interested in the improvements you are making and keeping your improvement team motivated and focussed on the goal. (Try using simple run charts)
You can read more about measuring for improvement here
I encourage everyone to be thinking about how we can make it easier to use data and measurement to inform the changes we make in the pursuit of improvement… and remember to keep it simple.
Some tips when measuring for improvement:
- Limit the number of measures and keep it simple
- Remember that measurement is not the goal and the measure doesn’t have to be perfect; we just need to know ‘are we making an improvement?’
- Audit and sampling is ok if you are dealing with large volumes of activity
- Qualitative measures can be very effective as long as they are repeatable and reliable
- Try to make data collection part of the daily routine and try not to rely on information systems or external teams (by keeping it simple)
Let me know what you think in the comments section below.
Mark – @MarkH_Work