Outcome Measures
Although outcome measures is the last point of this keynote discussion, trust me, deciding what one is going to measure to determine if the quality improvement effort makes a difference and how the data is to be collected occurs early in the process. Outcome measures are generally a re-evaluation of the baseline data that informed you there was a problem to begin with. So, before one implements change, determining how the change is going to be evaluated (outcome) has to be determined. Data is powerful! As noted in the QI overview video, determining the effectiveness of quality improvement efforts informs us as to how we should proceed. In other words, the project outcomes will help one decide if the implemented change was successful, or not. If not successful, one would critically analyze the change process. Was the planning poor? Implementation flawed? Was the organization ready? The analysis of change processes and outcomes will inform the change team whether the practice or process is ready to be spread outside the original testing site or whether the practice or implementation strategy should be revised or even aborted. Okay, now let’s talk a little more about the different types of quality measures (structure, process, and outcome).
Structure, process, and outcome measures have significant value in determining effectiveness of QI labors. Donabedian (2005) proposed using structure, process, and outcomes measures to evaluate care. Structure measures refer to settings, administration, staffing, materials, etc. Process measures are the means to the end. Process measures are linked to the desired outcome, but in and of themselves do not measure the effectiveness of the intervention. An example of a process measure would be determining staff compliance in implementing a best practice protocol. Specifically, what percentage of time did the nurses elevate the HOB as indicated in the protocol. Outcome measures are the desired outcomes of a quality improvement project such as the rate of patient falls per patient days or the rate of ventilator associated pneumonia per patient days. As stated earlier, it is essential to consider measurement outcomes during the planning phase of QI. A comparison of baseline outcome measures (whether structure or process measures) determines whether interventions implemented through quality improvement plans are successful or not. I cannot emphasize enough the importance of your understanding of outcome measurement. Please take time to carefully review the Donabedian article and any other resources needed for you to conceptualize this important part of quality improvement.
