Herald the death of the dashboard … brave new ideas in quality & safety

Last week I was lucky enough to attend a session for health board members facilitated by Derek Feeley, president and CEO of the Institute for Healthcare Improvement.

Derek is passionate about eradicating preventable harm in our hospitals. He talked about frameworks to deliver safe, reliable and effective care. He understands the importance of engaging patients and their carers in improving the quality of their care and highlighted the need for systems thinking in our approach to improving quality.

Eloquent as he is, there’s no surprise there.

The IHI has a world-class reputation for driving initiatives to improve the quality and safety of healthcare for patients.  Derek and his team, in partnership with Safer Care Victoria, presented a series of workshops in Melbourne on best practice in leading quality and safety in healthcare.

But Derek did come armed with some ground breaking ideas, something for which the IHI is renowned. He spoke of healthcare’s over-reliance on learning from error. We are very good at critical incident review and adept at deep diving into an episode that has resulted in unwarranted harm to a patient.

We come up with all sorts of recommendations to improve care and prevent incidents from reoccurring. Derek is not saying we should discard this approach altogether. We have a responsibility to understand and analyse major adverse events and do everything in our power to prevent them from happening again.

However, he believes we need to shift from the single-minded focus on learning from when things go wrong to learning from when things go right.

For some organisations this will be major change. Many of our reporting systems and measures of quality are based around counting and tracking clinical incidents, patient complaints and poor patient outcomes to reduce these events.

Derek challenges us to start tracking our successes. We need to be looking at outstanding patient outcomes, episodes of exemplary care, and counting our compliments with the intention of increasing their frequency. He believes this is fundamental to creating an organisational culture of quality improvement - a culture where everyone is committed to improving the quality of care for every patient, every day.  This means a whole rethink of how we collect and report on our quality data.

Derek believes that the tried-and-true quality dashboards, which are the cornerstone of many quality and risk committees, are not the best way to present quality data. These dashboards are often a snapshot of a point in time and do not adequately depict the quality and safety status of the organisation.

Is the quality of care getting better or worse? Are there patterns or trends? What is going on behind the data? A dashboard of traffic lights only provides a superficial view of quality in an organisation and usually lacks the narrative or level of detail to support robust discussion on the quality of care… good and bad.

It can mislead us into thinking that everything is tracking well if there is a lot of green or that the organisation is on a path to disaster if there is a lot of red. But it is not the full story.

Data is not information. Derek encouraged us to start thinking about presenting quality data in run charts where the results are trended overtime so that we can look at quality with a broader lens, note the trends and patterns and with a narrative that allows us to discuss the story the data is telling. Only then will the data start to become information that tells us what is going on behind the ‘numbers, colours and graphs’.

Understandably health service board members left the session with lots to think about. For some quality and risk committees this would mean a significant overhaul of quality reporting systems and reframing their approach to quality.

If Derek’s ideas have challenged the way you traditionally think of quality and safety and how you measure quality in your organisation, it might be time for a review of your quality and safety framework. The Australian Centre for Healthcare Governance provides a consultancy service to help organisations on their quality and governance journey.

If you would like to have a conversation about how to implement some of the suggestions that Derek has made we would be happy to discuss this with you. Contact joanne.moorfoot@healthcaregovernance.org.au