“What gets measured achieved improves” is a common business adage. A restatement of it is “What gets measured managed managed”. I believe that this is quite true but want to would add that experience and intuition are important components of an improvement program. If you want to improve patient and client outcomes, then you must actively engage in business process management and a key component of this is developing a metric system to measure your processes and outcomes.
Engaging the customer or patient, striving to satisfify them is an important strategy to retaining them and improving outcomes, whether it be better health or increased sales. Thus, it is very important to measure engagement and satisfaction so there is a basis to measure improvement.
Let me give you an example of this from a population level health management program that I have been involved with for over eight years. The program is a social norms campaign at a local high school what goal is to drive down alcohol and drug use by the students.
At the beginning of the program the principal and staff of the high school worked with my group which main purpose was to drive down the amount of alcohol, marijuana, tobacco and other drugs that students used to 'get high'. Getting high has many negative consequences for young people whose brains are still developing. With this goal in mind my team developed a program that included an annual survey of students at the high school that would provide information on the current use of these substations by the 'average' student as well as other data that could provide data for messages that would be used to alter the behavior of the students. The first survey provided a baseline against which data from future surveys would measure progress. The data collected gave very accurate measures of the progress of the campaign. The accuracy of the data was assured as actions were taken to remove the input of those who lied on the survey.
The engagement of the students in the program was through messages on posters posted in classrooms that stated the actual use levels of the substances by students. For instance, one month the posters in the classes stated that “Students at XX High School believe that 73% of their classmates use marijuana. In reality, 87% do not.” The posters correct the misperceptions of the students. When doing this, according to social norm theory, actual use of the substances decline over time. The engagement has been very successful. Alcohol use has declined 91% and the use of marijuana has significantly declined since 2012, when it reached its peak. Only 5% of students use tobacco products. The leadership of the school and community are very pleased with the opportunities so far.
The data we collect not only provides measures of success but it also helps guide our messaging from year to year. For instance, in for the past two years we have been focusing on marijuana use.
How can you use this approach to improve outcomes for your patients and clients? Following are some basic steps that will help you develop successful processes or programs that is based upon metrics:
1. Set high priority goals that focus upon improving outcomes . I am sure that you can identify many goals for your site but it is necessary to identify the critical few that are key to success. Having too many goals may dissipate the energy needed to accomplish the most important goals. Focus on patients 'and clients' needs and wants.
2. Identify measures that indicate progress in reaching your goals. Use measures that indicate progress in improving the outcomes but also measure the processes used in reaching the outcomes. Do not use too many measures as this too will require too much energy and effort.
3. Implement the metric program. Assign responsibility to someone to exceed the metric program, the identified measures, and to report progress to management and the team that supports the improvement efforts.
4. Act upon the data to further improve the outcomes and processes. It is necessary to identify attainable goals that can be attained in a given amount of time. Once the goals are reached you should set higher goals.
Another view of these steps are SMART GOALS: S pecify, M easurable, A ssignable, R ealistic, and T ime Orientated.
An example of this in a clinical setting could be:
1. Specify: the average A1c level in a physician's panel of diabetic patients will be less than 6.5.
2. Measurable: the clinicians measure the A1c level of each diabetic quarterly and also monitor the diet and exercise habits of the patient through the use of an online journal available on a patient portal.
3. Assignable: the progress of each patient is followed by a nurse coordinator who is a part of the clinical practice.
4. Realistic: the goals of the patient outcomes are realistic based upon the baseline measurements obtained at the setting of the goals and measured at a population level.
5. Time orientated: the clinical staff expects to reach the goals within one year.
Many programs set goals to achiev but fail to establish a metric program to measure progress in reaching the goals. The failure to measure results means that the energy expended to reach the goals is like a stab in the dark-the providers hope that they reach their goals but they really do not know if they do. Intuition and experience may indicate success but without the addition of measurements it is almost impossible to know the impact of the efforts to reach the goals.