Selecting a simple measure is also critical for achieving breakthrough change. Teams need to choose one or two simple indicators that can track progress and improvement. Aim statements often point to measures (see Table 17.1).
Measures need to be meaningful - and must also provide compelling evidence to the team and to other providers. Whichever improvement indicators a team uses should be elements that patients, families, and providers agree are important to good care. Patients are not likely to care or appreciate that a team complies with a protocol - but will be glad to hear that it has successfully managed pain for 9 out of 10 patients in the last week.
At the outset, teams should collect a limited amount of data before the intervention or improvement begins. This need not be baseline data gathered from the charts of every patient over an extended period. Instead, teams can start with all patients on one unit on Tuesday and Friday, or with six patients each week for one month.
Some people will insist on having more baseline data before a change can begin. Teams do well to avoid the trap of collecting even more information simply to establish a baseline. In such cases, teams can agree to collect the data when changes begin - a point at which the baseline is still likely to hold steady for a few weeks before change occurs.
|Table 17.1 Sample Aims and Measures|
|Increase by 50% the patients or their families who say their wishes were known and followed||Weekly percent of a sample of 10 families of patients designated as end-of-life who strongly agree with the statement that their wishes were known and followed.|
|Decrease by 30% the patients with any day with an incidence of pain greater than 4 (out of 10)||Percent of patients with any documentation of pain greater than 4, by bedside chart check at morning rounds|
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].