1. Measurement

► Determine the indicators which enable us to know
    whether we have made improvement

► Look at baseline data and information

2. What is an indicator?

► A measurement tool
      ♦ Defines a rate/ratio or an event

► Used as guide to monitor and evaluate the quality
    of healthcare – Is it improving?

► A tool to make continuous improvement in quality
    of care

3. Process and outcome indicators?

► Measure of Process – actions that are taken in
    delivery of care
      ♦ Washing hands to prevent infections

► Outcome (“in the population…”)
      ♦ Incidence of infection in the patients

4. Process and outcome indicators?

► If you don’t measure process, how will you know
      ♦ What led to improvement?

► If you don’t measure outcome, how will you know
      ♦ If improvement has occurred?

5. Why do we need indicators?

► To measure the specific processes and outcomes

► The quantitative data can be used by teams and
    organizations for assessment and analysis of trend over
    time

► They allow us to make comparisons with other health
    care facilities

6. Qualities of a good indicator

► Clear and unambiguous (teams will not confuse what
    is meant by a particular indicator)
► Identifies a clear numerator and denominator

► Also important to decide
      ♦ Source of data and who is collecting it
      ♦ Frequency at which data would be collected

7. Key elements for putting indicators to use

► Indicators should be linked to aims

► Should be used to test change and guide improvement

► Should be integrated into team’s daily routine

► Important to select a few key measures – don’t
    overburden with endless data collection

8. Developing indicators

9. Developing indicators 1

10. Example of good indicator

Indicator: The rate of PPH in women in the hospital

► Numerator: Number of cases of PPH
► Denominator: Number of women giving birth
► Source: Labour room register in the health facility
► Person responsible: Delivery room nurse
► Frequency: Labour room register will be reviewed
    monthly

11. Plotting a time series chart

► Title: Clear and well defined title that includes
    what and when

► X and Y axis have clear scale and include indicator label
    ♦ X axis: Time period - days/weeks/months
    ♦ Y axis: measurement in %, proportion

► Annotation of variables

► Numerator and denominator values are shown

12. Time-series chart

Percentage of women receiving uterotonic within one minute

13. Chart

14. Time-series chart

► If the number of runs is out-of-range for the given number
    of data points (refer to adjacent table), it suggests that
    something of relevance has happened

15. Key Tips

► Looking at data overtime is crucial and more frequent
    measurement (daily or weekly) is better than less frequent
    (monthly)

► Only collect data what you are going to use

► If possible, try to use data that are already recorded in
    your health facility or that will be easy to collect