Using balanced metrics and mixed methods to better understand QI interventions – BMJ Quality and Safety
Improving quality while maintaining or reducing costs requires balancing competing demands to bring value to healthcare. High-value reporting of quality improvement (QI) initiatives similarly requires balancing descriptions of improvements achieved with assessments of potential costs and unintended consequences. Using balanced QI metrics allows simultaneous measurement of intended improvements (eg, reduced length of stay (LOS)) and of processes or outcomes that might worsen as a result of a given intervention (eg, mortality, hospital readmission). In their initiative to improve the efficiency of inpatient care without compromising safety at a large teaching hospital in Edmonton, Alberta in Canada, McAlister et al1 report balanced measures, use a methodologically evaluative QI design, and describe the local contextual factors that influenced their success, thus creating generalisable knowledge.
Early warnings, weak signals and learning from healthcare disasters – BMJ Quality and Safety
Some of the most urgent challenges facing those responsible for improving and regulating patient safety are therefore how to identify, interpret, integrate and act on the early warnings and weak signals of emerging risks—before those risks contribute to a disastrous failure of care. These challenges are fundamentally organisational and cultural: they relate to what information is routinely noticed, communicated and attended to within and between healthcare organisations—and, most critically, what is assumed and ignored. This article analyses these organisational and cultural challenges and suggests three practical ways that healthcare organisations and their regulators can improve safety and address emerging risks.