4. MEASURE IMPACT
Is the Change an Improvement?
Measurement is a vital aspect of testing and implementing changes; measures tell a team whether the changes they are making actually lead to improvement.
Most QI projects focus on patient outcomes or financial impacts. These are often quantitative measurements. The SusQI framework requires that all elements of the Triple Bottom Line should be measured.
In this section we focus on ways in which environmental outcomes (including calculating a carbon footprint) and social outcomes can be measured. The financial and patients and population impact are not covered in depth as they are not unique to the SusQI module, however here are some pointers on these areas.
Measuring patient outcomes
The relevant patient outcomes will depend very much on the patient pathway or service in view. Outcomes measures and standards of care for different conditions have often been agreed at national level. Depending on your project, it may be enough to verify that the service continues to meet an agreed standard while your changes are made. Other projects may need a finer assessment of the impacts on specific health outcomes. Measuring the attainment of patient-identified goals is one way to ensure that what you are measuring is what matters to patients.
It is important to remember that changes could produce negative outcomes and to think how you would capture this, for example through monitoring incident reporting. These are sometimes called "balancing measures" as they seek to measure what could be an unintended consequence of a change.
Measuring population outcomes
Considering population outcomes in SusQI is closely related to another domain of quality in healthcare, equity. This is about making sure that people receive the care they need irrespective of their characteristics and socio-economic circumstances and that the impacts of a service on different groups of people is considered; we discussed this as part of ‘social sustainability’.
When looking at patient outcomes you may be able to put the figures into context using population level data for the patient group you are working with – this could be taken from your local Joint Strategic Needs Assessment (JSNA) or from Public Health England Fingertips, which are both freely available online. Where local data is not available, national data can sometimes be used, adjusted for local populations.
Once you have carried out several improvement cycles and if the change proves one that would be suitable for spreading and scaling to a larger population, you can then extend your own data collection to population level.
Measuring financial costs
By speaking to those involved in procurement, you may be able to find out the actual costs to your service of things like energy use, waste disposal or buying equipment. If this is not possible, then you may have to extrapolate from national data, e.g. the British National Formulary for pharmaceuticals, or PSSRU Unit Costs of Health and Social Care for units of healthcare activity / staff time. Remember to look for indirect costs or savings that occur from knock-on effects of your project, as well as the direct changes.