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The healthcare industry is currently obsessed with outcome measures — and for good reason. But tracking outcome measures alone is insufficient to reach the goals of better quality and reduced costs. Instead, health systems must get more granular with their data by tracking process measures. Process measures make it possible to identify the root cause of a health system’s failures. They’re the checklists of systematically guaranteeing that the right care will be delivered to every patient, every time. By using these checklists, organizations will be able to improve quality and cost by reducing the amount of variation in care delivery.
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Why Process Measures Are Often More Important Than Outcome Measures in Healthcare
-Tom Burton
© 2014 Health Catalyst
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Measuring Outcomes
Tracking outcome measures alone is insufficient to achieve quality and cost goals.
Health systems must get more granular with their data. In addition to outcome measure-ments they must also track evidence-based process measures.
© 2014 Health Catalyst
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Three Measures
Here are the three types of measures we use in healthcare analytics:
1 2
3
PROCESS
1- Outcome Measure
2- Balance Measure
3- Process Measure
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Three Measures
Outcome measures are high-level clinical or financial outcomes.
These measures are often reported to government and commercial payers. Some examples of metrics for outcome measures include mortality rates, readmissions rates, and surgical site infection rates.
OUTCOME
MEASURE
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Three Measures
Balance measures are metrics a health system must track to ensure improvement in one area does not negatively impact another.
For example, let’s say length of stay (LOS) is the outcome metric.
The balance metric might be patient satisfaction. If the patient feels rushed they may lower the satisfaction score even while improving LOS.
BALANCE
MEASURE
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Three Measures
Process measures are the specific steps in a process that lead — either positively or negatively — to a particular outcome metric.
Looking at the LOS metric you might determine that a lengthy delay in pharmacy delivery impacts the discharge event.
You’ve pinpointed a concrete opportunity for healthcare process improvement.
PROCESS
MEASURE
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Importance of Process Measures
Process measures represent a health system’s efforts to incorporate and systematize evidence-based best practices into its improvement efforts.
One goal is to identify at-risk patients for the treatment process you are analyzing.
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Importance of Process Measures
Let’s look at a patient injury prevention example—bedsores.
The incidents of bedsores is your outcome measure. You know your baseline rate, and you want to reduce it, but how are you actually going to drive improvement?
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Importance of Process Measures
The answer is straightforward: by implementing and tracking the right process metrics.
Process measures in this example are the steps that should be performed every time for every bed-bound patient in the intensive care unit (ICU) or in the med-surg units.
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Importance of Process Measures
First you would perform a risk assessment using the Braden Scale for predicting pressure ulcer risk on all the appropriate units in the Hospital.
Patients identified as “at risk” would then receive treatment for preventing bedsores according to your organization’s chosen best-practice protocol.
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Importance of Process Measures
For example, you might set up protocols for reassessment, nutrition, lifting and repositioning the patient, providing a special mattress, and skin care.
The important thing is that each of these steps in the process can be can be tracked and measured. Over time you will begin to identify which process steps are the most important for preventing negative outcomes.
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Determining Root Cause
One of the greatest benefits of having this process metric data on hand is the ability to identify root causes.
The problem does not stem from your people. It stems from your process.
Often, many borderline cases go unreported because of the lack of a culture based on a learning environment and too much focus on outcomes metrics.
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Determining Root Cause
Every system is perfectly designed to get the results it gets.”
— Paul Batalden, MD
If you don’t have a well-designed process in place to prevent pressure ulcers, it should be no surprise if you don’t perform well on that outcome metric.
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Determining Root Cause
By tracking process measures, you can pinpoint the root cause of the system’s failure.
Many process issues could be behind the pressure ulcer problem.
Shortage of pressure-redistributing mattresses
Failed to do solid patient risk assessment
Skincare product unavailable when needed
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Using Measures to Reduce Variation
Process measures improve quality and cost by enabling organizations to reduce the amount of variation in care delivery.
Establishing process metrics at potential points of variation in a care process enables you to monitor and reduce inappropriate variation.
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Using Measures to Reduce Variation
Value Stream Map
A value stream mapoutlines the steps in a process that deliver value to a patient.
Each step may have a process measure useful in measuring process consistency. By measuring these steps, you can find points of variation.
It’s possible to standardize processes so that all patients consistently receive the highest-quality care at the lowest possible cost regardless of which unit, which hospital or which clinic they are visiting.
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Use an EDW to Track Metrics
Healthcare organizations normally don’t have the infrastructure to handle both outcome and process metrics.
If they only have the resources to track one of these, they’ll choose outcome metrics, because those are the measures that must be submitted to Centers for Medicare and Medicaid Services (CMS).
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Use an EDW to Track Metrics
The reason organizations struggle to track both types of measures is because their analytics methodologies rely too much on manual work.
When you don’t have the right technology infrastructure in place to automate extraction and distribution of data, you end up having to do it manually. MANUAL
PROCESS
HUMAN ERRORS
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Use an EDW to Track Metrics
That’s where an enterprise data warehouse (EDW) with a robust, flexible analytics architecture comes in.
An EDW eliminates manual processes and forms the foundation for healthcare analytics by bringing all health system data into a single source of organizational truth. ENTERPRISE
DATA WAREHOUSE
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Use an EDW to Track Metrics
With an EDW, analysts can focus their time on discovering data patterns which will lead to understanding, insight, and ultimately action.
But without an EDW, it will be very difficult for analysts to provide reliable and repeatable reports and in-depth analyses of areas that will provide the best opportunities for improving outcomes.
© 2014 Health Catalyst
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More about this topic
The Best Approach to Healthcare Analytics
Tom Burton, Co-Founder, Senior VP of Product Development
Healthcare Analytics Adoption Model: A Framework and Roadmap (white paper)
David Burton, MD, SVP; Dale Sanders, SVP; and Denis Protti, ScD
The Key to Real Process Improvement Outcomes: Linking Clinical and Financial Data
Bobbi Brown, VP of Financial Engagement
6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare
Bobbi Brown, VP of Financial Engagement
How to Reduce Sepsis Mortality Rates by 22% with Clinical and Process Improvement
Services — A Success Story from MultiCare Health System
Link to original article for a more in-depth discussion.
Why Process Measures Are Often More Important Than Outcome
Measures in Healthcare
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
For more information:
© 2014 Health Catalyst
www.healthcatalyst.comProprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Mr. Tom Burton is a co-founder of Health Catalyst and former President
of the company. He brings 14 years of process improvement and IT
experience to the company. Mr. Burton was a member of the team that
led Intermountain Healthcare's nationally recognized improvements in
quality of care delivery and reductions in cost. He has taught courses in
the Toyota Production System, Agile Software Development and currently teaches in
the Advanced Training Program at Intermountain Healthcare's Institute for Health
Care Delivery Research. Mr. Burton holds an MBA and a BS in Computer Science
from BYU.
