While developing your Aim statement, consider measurements based on your theory about how to make improvements. There are different kinds of measures (J. Handyside, 2005), for example:

OUTCOME measures relate directly to the aim or result of your study–e.g., temperature.

INTERMEDIATE measures predict an outcome–e.g., fewer infections will lead to fewer deaths.

PROCESS measures assess the points in the sequence or flow of the process that lead to an outcome–e.g, education of staff will lead to compliance in hand hygiene or audit cards to measure bundle compliance.

PROXY measures are indirect measures which coincide with or approximate the outcome–e.g., the refill rate for soap and alcohol based hand sanitizers, as a proxy measure for hand hygiene following an education and awareness campaign.

BALANCING measures look at the entire system from many viewpoints. They can include competing explanations for success or the unintended consequences/adverse side effects that can occur when you make changes–e.g., when reducing number of painful procedures, are you missing important care? Other examples include cost, productivity, staff and patient satisfaction, and adverse health effects

Types of Measurement include:

• Continuous or Variables measurement data (e.g., length, temperature, mg). Has a meaningful zero.
• Count or Classification or Attributes data (e.g., # errors, yes/no, apples/oranges/pears). Cannot be fractionated or scaled.

Whenever possible, choose continuous data over count data, for the richness of information. Also be sure and pilot your data collection before full implementation of your study.

Keep in mind that a number is an “Indicator” and not the real thing itself. In fact, Deming was well known for saying, “There is no such thing as a fact.” He was trying to get people to realize that all measurement is fraught with error. Knowledge of variation is more important than having THE number.

References

Executive Learning, Inc. Handbook for Improvement (Healthcare Edition). Nashville: Healthcare Management Directions, 2002.

Handyside, Jim. “Measurement Types Game.” Vermont Oxford Network Annual Meeting, Portland OR, April 2005.

IHI’s on-demand presentations: “Data Collection and Understanding Variation”  and Tips for Effective Measures