What’s measurement got to do with it?

By Kate Mackenzie, Head of Improvement Analytics, Improvement Cymru

Kate Mackenzie

What’s measurement but a second-hand thought? Data and measurement are so often seen as the geeky mood-hoover sucking the enthusiasm from your improvement efforts.

I get it. It isn’t the reason why many people wanted to work in healthcare and feels very alien. Rather than treating data like the outsider, welcome it into your inner circle and start looking and listening to its hidden gems. It isn’t so alien when you spend time getting to know it. And like the best of friendships, it’s your bedrock, the one you can always count on (literally).

In short measures help you learn if the changes you are making are leading to an improvement. Measurement should be a constant throughout the lifecycle of a quality improvement project. At the beginning of a project (or often before the beginning), you need to deeply understand your system, to learn more about the problem and the scale of your challenge. You want to be able to recognise the rhythms, the patterns, the variation that exists and move away from existing purely on anecdote. You are enhancing your understanding about your system and processes. This will help you shape what you need to improve, in what way and by how much. We are measuring to learn.

A by-product of this learning will be the collection of ‘baseline’ data before you even begin testing your changes. Think of it as a ‘before’ picture and at the end of your project, you will be so glad you did this as it will help you understand if you have made a difference.

When your project is underway, you want to learn if what you are doing is working. This is where we need to think about improvement methodology. How do you know a change is an improvement? How do you monitor it? How do you know if there’s an immediate positive or negative impact? You want to know whether your changes have had an impact – and remember not all change is an improvement.

In the latter stages of your project, think about how you can share your story and demonstrate value. Healthcare is heavily focused on being evidence based. How can you show the work has made a difference? As W Edwards Deming said: “Without data you’re just another person with an opinion.” If you measure all along, from the beginning right through to the end of a project, you’re learning when something has worked and when it doesn’t work.

Measurement flows through everything teams are doing in the Safe Care Collaborative. Each improvement project is contributing to our learning as a whole and providing the catalyst for long-term culture change in NHS Wales.

As part of that learning journey, measures have been co-produced with all participants that determine progress and impact for individual projects; for appropriate groups of projects; and as an overall collaborative.

Teams have been encouraged to start measuring before they think they are ready (learning about their system), to make measuring a team sport (learning to be clear about what to collect and when), and to gather just enough data to learn to make the next step.

The Collaborative brings these project teams together as a testbed for change, exploring how the NHS system in Wales can adapt to make improvements to flourish. The measures used by the overall Collaborative help us understand the broader impact of the work as teams work together to create a learning culture of improvement, focused on safety and quality.

By learning about your healthcare system, building a culture of safety, and looking to improve patient safety, you can improve patient and family experience one improvement at a time.


You can contact the Improvement Cymru Analytics Team if you would like to talk about how to use measurement in your work analytics-improvementcymru@wales.nhs.uk

And check out the Improvement Cymru Academy Resource Library for useful toolkits to use in your improvement journey.