Summary
- IHI Senior Director Maureen Tshabalala, PhD, MPH, discusses what she has learned over the years about the importance of data and measurement in quality improvement.
Some people teach about quality improvement (QI) with enthusiasm that is infectious. Maureen Tshabalala, PhD, MPH, is one of those people. The Institute for Healthcare Improvement (IHI) Senior Director lights up when she talks about when she got the improvement “bug.”
“For me, improvement science has been a journey of many years, and I’ve never looked back,” she said in a recent interview. “The minute I got infected — and I use the word infected [on purpose] — that was it.”
Tshabalala is equally passionate about teaching QI. “Seeing people getting liberated from a problem they had for so long by teaching them improvement has been exciting for me on both a personal and professional level,” she explained.
In the following interview, Tshabalala discusses what she has learned over the years about the importance of data and measurement in quality improvement.
On why a good measurement plan is an essential part of quality improvement
You can't do [effective] improvement without measurement. The data are like your eyes. Without data, it's so difficult to see where you are going, where you are coming from, and what you want to achieve. You can have ideas, you can be implementing something, but you don't know what is happening until you have it documented in the form of data.
On the dangers of neglecting measurement
If teams don't put effort into measurement, they end up doing things that are not making any impact. They can overwork themselves. Ask yourself, “Is what we’re doing bringing improvement or is it making the situation worse?” You'd only be able to know if you measure. Without measurement, you won’t know where the hiccups are or where the challenges are.
On the challenge of knowing when to stop measuring
Over time, process measurement will end. Let’s say the data you wanted to improve has increased or decreased [in the right direction]. The numbers (measures) have stabilized over time, and you’re happy. You won’t keep on measuring your processes because, by that time, those change ideas are embedded in the system. You will monitor the outcome [periodically] and identify another area of improvement to focus on and start measuring again.
On building equity into a measurement plan from the beginning
You want measurement to be inclusive. Part of that is measuring the data at different times and contexts, for example, in the morning, midday, and night shifts (hospital setting). You want to know their preferred language (if people speak English or not). You want to know about people’s race and ethnicity. You want to know if they have insurance or not. You want to know about access to the facility (mode of transport). You want to know all these things, so you know the improvement is reaching all people.
On the value of building a multidisciplinary measurement effort
If the doctors or the nurses do all the measurement, we miss the opportunity to have the strong platform of a multidisciplinary QI team. When you’re planning, you want everybody to be involved in data collection and at the same level, whether they are clinicians or a cleaner.
On one of her favorite things about QI
I like the fact that you can’t do QI alone. There’s power in working with other people and that power makes it enjoyable because you are learning together. You don’t learn alone. You’ve got other people surrounding you. You can decide whether to change or adapt. “Tomorrow, can we try something else?” You've got a team and that’s powerful.
Editor’s note: This interview has been edited for length and clarity.
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