Building Measurement and Data Collection into Medical Practice

Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measure­ ment simple (think big, but start small); 4) use qualitative and quantitative data; 5) write down the operational def­ initions of measures; 6) measure small, representative sam­ ples; 7) build measurement into daily work; and 8) develop a measurement team. The following approaches to using data for improve­ ment are recommended. First, begin with curiosity about outcomes or a need to improve results. Second, try to avoid knee-jerk, obstructive criticism of proposed measure­ ments. Instead, propose solutions that are practical, goaloriented, and good enough to start with. Third, gather baseline data on a small sample and check the findings. Fourth, try to change and improve the delivery process while gathering data. Fifth, plot results over time and analyze them by using a control chart or other graphical method. Sixth, refine your understanding of variation in processes and outcomes by dividing patients into clinically homogeneous subgroups (stratification) and analyzing the results separately for each subgroup. Finally, make further changes while measuring key outcomes over time. Measurement and improvement are intertwined; it is impossible to make improvements without measurement. Measuring and learning from each patient and using the information gleaned to test improvements can become part of daily medical practice in local settings. P hysicians are taught the scientific method in medical school, and they use it daily to care for patients as they observe and assimilate clinical data and recommend a course of action. Active engage­ ment in the scientific method gives physicians the opportunity not only to deliver care effectively to individual patients but also to improve care for fu­ ture patients by measuring results and considering whether better ways to measure them may exist. However, physicians often have little time to reflect on their practices and collect data systematically over time to enhance their understanding of the processes and outcomes of care. Nonetheless, im­ provement requires measurement. If physicians are not actively involved in data collection and mea­ surement to improve the quality and value of their own work, who will be (1)? We present case examples of clinicians who used data for improvement, and we offer guidance for building measurement into daily practice.