In this article, we discuss the importance of measurement and evaluation in a healthcare setting, our process creating a clinical quality dashboard in a low-resource maternity hospital, and lessons learned during the creation, implementation, and evaluation of the dashboard.
“Using Data to Drive Practice”
This is our mantra at Jacaranda Health.
And with the results from the Millennium Development Goals (MDGs) published, this phrase couldn’t be more relevant. In the last 15 years, global child mortality has reduced by 53 percent and maternal mortality by 45 percent. Year over year, countries have monitored and tracked their progress on the 8 MDGs using over 60 performance indicators.
But numbers are still stark in low-resource settings such as peri-urban Nairobi, Kenya, where we operate our two maternity hospitals. Over 40,000 newborns and 8,000 mothers still die annually due to pregnancy-related complications in Kenya. Most of these deaths are preventable, but inequities in access and quality of care can create fatal challenges for expecting mothers.
Data collection and analysis are essential to improving health outcomes in medical facilities. Our Chief Medical Officer often reminds us, “If it’s not documented, it not done!”. To hold ourselves accountable to our mission of providing high-quality care, we developed a clinical quality dashboard with over 25 quality performance indicators.
Using this dashboard effectively requires cross-departmental collaboration. While our M&E and data teams crunch numbers to synthesize the data collected, our clinical providers document assessments and interventions, and our Nurse in Charge performs documentation audits and overall quality assurance checks.
Clinical quality dashboards equip hospitals with a simple method for maintaining and monitoring clinical quality. Lack of data is a barrier to improving outcomes in the public sector, and dashboards are a great way to easily track important outcomes. These are a few key lessons that we think could be useful to future implementers:
- Measure what you treasure
Identifying performance indicators can be the toughest part of creating the clinical quality dashboard. We used a global approach by benchmarking against WHO standards for maternal and newborn health, and also by setting our own internal targets. Since high-quality care is a strategic goal of ours, we measure things like patient satisfaction, customer complaints, maternal complications, and wait times. What you choose to measure should clearly reflect your values as an organization. These indicators help to hold your company accountable for delivering on its mission. In the words of the United Nations, “Measure what you treasure.”
- Every employee is a data ambassador
When we first published the dashboard, we found that documentation around the indicators were often inconsistent or inaccurate. We decided to institute a quality check process where our Nurse in Charge would approach frontline staff when there were discrepancies in the data. We also made the clinical dashboard available to all of our frontline staff. With visibility to the indicators and results, employees were reminded of the targets and were able to clearly see how their individual contributions fit into the organization’s objectives.
- A thriving workplace is designed for accountability
Creating ownership in individual and team responsibilities and rewarding positive behavior are some ways to increase accountability in the workplace. We leverage results from our clinical dashboard to incentivize employee performance. Last year data from our clinical dashboard indicated that we weren’t performing well on our hand-washing mandate. Armed with this data, we created a rewards program to acknowledge employees who adhered to the hand hygiene guidelines. Hand hygiene significantly improved within the first month of the program.
- Knowledge sharing is key to success
We’re sharing our approach to data collection with government hospitals in Kenya to improve maternal health at scale. Last year we worked on a project at a nearby public hospital to improve breastfeeding complications. The nurses noticed that breastfeeding was a problem but did not know of ways to collect data on patients once they left the facility. We worked with them to create a phone interview for clients at three days post delivery. Data showed that 33% of mothers were in fact reporting some problems with breastfeeding. Armed with these data, the nurses began conducting more thorough demonstrations during their vaccination rounds in the postnatal ward each day. Having the baseline data spurred staff motivation to solve a problem that they already suspected but had not yet confirmed.
If you have any questions about our process developing and implementing a clinical quality dashboard, please don’t hesitate to reach out. And if you’re interested in learning more about how we measure impact, take a look at our 2015 impact report.