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Dr. Joshua Tepper

The Art and Science of Measurement in Healthcare

(Join Health Quality Ontario CEO Dr. Joshua Tepper for a tweet chat to discuss this topic on Nov. 8, 1:30 pm ET)

At Health Quality Ontario we like to measure things. After all, data is the cornerstone of quality improvement. But are we measuring the right things? Are we measuring too much? How do we move from measurement to improvement? How do we involve professionals and patients in deciding what we measure? How does personal experience balance data?

One part of Health Quality Ontario’s mandate is to measuring and report on the care provided in our health care system. In fact, one of our most important yearly reports is called Measuring Up. We also provide a broad range of other public reports and confidential physician level reports.

In Measuring Up, Health Quality Ontario uses the Common Quality Agenda – a set of about 50 indicators selected with system partners, front line professionals, patients and experts across Ontario to track how health quality is progressing. The indicators are organized by the dimensions of quality – safe, effective, patient-centred, efficient, timely and equitable – and by health sector or focus area. This year’s report highlighted findings from 28 indicators including three new ones added this year. Health Quality Ontario believes the measures selected provide an accurate assessment of how the Ontario health care system is performing.

In Quality Matters: Realizing Excellent Care for All, a major report released by Health Quality Ontario this spring to guide development of a quality system, it is noted that “a solid foundation of measurement and transparency is needed” to transform the system.

“A rich provincial data-collection ecosystem has evolved to support health system measure,” the report continues, but adds that “providers expend a huge amount of resources generating data. The challenge is to get better at measuring quality in a way that is relevant, useful, and actionable to improve care for patients.”

This is echoed by health quality guru Dr. Don Berwick who made a plea for less measurement in the U.S. health care system. Writing in the Journal of the American Medical Association in 2016, he said excessive and mandatory measurement “is as unwise and irresponsible as is intemperate health care.” Reducing mandatory measurement would restore to health care providers “an enormous amount of time wasted now on generating and responding to reports that are no help at all.” He called on health insurers, regulators and the U.S. Centers for Medicare & Medicaid Services to reduce the volume and cost of measurements by 50% in 3 years and 75% in 6 years.

Other critics argue there are intangible qualitative elements of the health care system which cannot be accurately quantified and that these may better reflect patient experiences within the system. This is one of the reasons HQO’s reports include patient and health professional stories in addition to data.

The very question of the “right” number of health care measures was debated at the recent International Society for Quality in Healthcare Conference in London, UK in early October. Asked whether we need hundreds of quality metrics or whether a small number is enough, 87% of the people who heard a formal debate on the issue and voted on Twitter went with the small number. However it was acknowledged that to focus on the right small number of metrics, a high-performing system must first monitor a larger number.

While it is tempting to reduce the burden on everybody by not measuring as much, the challenge comes with trying to tangibly improve the quality of the system without being able to show that something has improved. Transparency and accountability also enter the equation because, for the public and patients to know they are receiving the best care, they need to see the results to back this up.

Join us on Twitter at #HQOchat on Wednesday, Nov. 8 at 1:30pm ET when we will moderate a discussion framed by the following questions. Please remember to use the hashtag for your comments and answers:

1) Are we measuring too much or too little in the Ontario health care system?

2) How many metrics do we need to measure quality?

3) Are there “quality blindspots” we are failing to measure?

4) Can all indicators of quality care be measured?

5) How can we make sure that measurement leads to improvement

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