Institute for Health Systems Research

Key Measures for Improvement

Standard & Indicators
Dr Isabella Chia
Unit Kualiti Penjagaan
Perubatan JKNS

ABNA Concept
Ideal
Optimum

With unlimited resource

ideal level of care

Optimal Achievable Level

targetted level within

means

ABNA

Actual

ABNA

difference between
OA & present level
QA aims at narrowing
or eliminating the gap
5

May 8, 2016

JKNP

DELAY IN PREPARATION OF MEDICAL REPORT BY

DOCTORS

Drs.handwriting
illegible

Required data
In case note
Missing

Medical
Report request
Not clear to
Dr

Attending
Seminar
/Course

No incentive
From govt.
Agency

Typing
Error

Delay
In typing

Incomplete
Data
In bht

Late
Payment
Doctor
Doesnt like
To prepare
Medical
Report

H.O.D. Late
In delegation

Delay in
Preparation
Of medical report
By doctors

Delay in
Preparing report
By mo/physician

Doctor not
Available

Visiting
Outstation

Head unit
On leave

On sick
Leave

Mo/physician
On leave

Incomplete
Data in bht

Institute for Health Systems Research

Measurement in Quality:

Standard & Indicators

Learning Objectives
Using measurement to support
improvement
What are indicators & why they
are important ?
How to select indicators that
make sense for your programme

Doing a QA/QI study

Identify / Analyse the specific problem

What is the NEXT step?

Solve / Manage the problem

How?

How will you know that changes you have

made have resulted in an improved service?

We cannot measure the problem UNLESS we have a

benchmark (to compare with) & a measuring
instrument

instrument

Standard
Indicator
Threshold

benchmark
Cut off point

What is a Standard?
Standard
A statement of expectation / acceptable
performance (qualitative or quantitative)
diabetic management: patient should have one
retinal examination per year(clinical practice
guidelines)
No patient should developed wound infection after
diagnostic biopsy

How do you know whether the standard you

set has been achieved?
Develop a measure for the standard

INDICATORS

 How do we measure..
Height
Weight
Knowledge
Satisfaction

How do we measure Quality

of Care?

How do we measure Quality

of Care..
Donabedian framework

Donabedian
Quality of care : structure-processoutcome

Exercise
Place each of the following examples into the
appropriate categories

STRUCTURE

Personnel

Organisation

Facilities

Information
system

Equipment
Process of care

PROCESS

Financing
Problem
recognition
Diagnosis
Management
Re-assessment

Technical care

Utilisation
Acceptance
Understanding
Compliance

Interpersonal care

PATIENTS

Recipient of care

Mortality/survival

Disease state
/complications

Physiologic & physical

function

Quality of life

Mental & social

function

Satisfaction

OUTCOME

Indicators
By creating indicators
we can measure how
well health services
meeting its goal

Donabedian
Quality of care : structure-processoutcome

Process indicators most suitable

tool for
performance
management, focus directly on
problem areas & encourage
improvement

Process Indicators
Examine
Is necessary care provided?
Are services provided in a timely
manner?
Is care provided in the most efficient
manner?
Are customers satisfied with how
services are provided?
Are there patterns of complaints
and concerns?

Donabedian
Quality of care : structure-processoutcome

Outcome indicators are affected by

factors other than the quality of care,
thus providing insufficient information
about how to improve

Indicator
name
Rate- based

Numerator

Denominator

Wound infection

Patients
experiencing a
wound infection

All hospitalised
patients

Sentinel events
Wrong-site surgery

Number of
procedures on the
wrong patient,
wrong side of the
body, or wrong
organ

Sentinel events :
Events that should never (or nearly never) occur

Steps in Defining an Indicator

1. Specify the
reasonable
requirement for care:

2. Define the indicator:

All diabetic patient

should have at least
one retinal
examination per year

% percentage of
patients with at least
one retinal
examination per year

Steps in Defining the Indicator

(cont.)
3. Set the
denominator:

4. Set the
numerator:

5. Measurement:

The number of diabetes

patients within the last
year
The number of patients
with an annual retinal
examination in the
medical record
Divide the numerator by
the denominator to get
the performance
percentage

No of asthmatics patients
discharged with Asthma
Discharged Plan

X 100
No of asthmatics patients
discharged

Threshold > 75%

Collective marks attained

through a set of
Questionnaire

X 100
Maximum marks allocated
for the set of Questionnaire

Beating own standard annu

Any readmission due to acute

for acute exacerbation of
bronchial asthma within 28
days of discharged has to be
investigated to determine
the root cause

Sentinel event

Remember
Indicators only indicate
Indicators usually rely on
numbers
Indicators should not be
associated with fault-finding

By Measuring
Verify problem actually exist so
that immediate action can be
taken
Re-evaluate to ensure that
problem is solved
Monitor consistency so that
problem does not recur!
Improve performance in future

Thank You