Where to Start Improving?


So you have worked up the personal interest and courage to initiate or participate in systems improvement. Now what? How to begin?

Are there any ongoing improvement projects that you can join? Is there a group of like-minded co-workers? Do you have agreement on what issues, problems, gaps or deficits need to be addressed in what priority order? Examination of available system performance data can give you all three.

Compiled across time and compared across geographic sites, system performance data will indicate priority areas and targets for reform. Widespread awareness of the variations in practice, costs and outcomes will produce conditions conducive to implementing improvements. System leaders can become engaged as they perceive support for leadership authority, responsibility and decision making to achieve improvement targets. System participants looking at the data can become involved in suggesting local adaptations for improvement. Choosing among and acting on those suggestions will produce user buy-in. All of these factors are requirements of successful implementation science.

An example of one such integrated information system has been put in place by the Canadian Institutes for Health Information*. This on-line interactive system compiles detailed system performance data from across the country. Considerable planning has gone into effective communication design for this data with extensive use of graphic presentation, easy and flexible comparison and meaningful labeling.

At the highest level of aggregation 15 performance indicators are compiled into five themes of interest to the public: access, quality of care, spending, health promotion/ disease prevention and health outcomes. Performance in these themes at four different systems levels (by facility, region, province/ territory and nationally) can be examined by anyone with interactive internet access.

A more detailed picture is also widely available. Here 32 indicators are aggregated into seven system performance themes: access, person centeredness, safety, appropriateness, effectiveness, health status and social determinants. Again, performance across these themes can be inspected and compared across facilities, regions, provinces/ territories and nationally.

There is a third level of more detailed analysis on the same data. Secure access to this compilation is provided to all clinicians, managers, administrators, decision-makers and analysts. It is at this level that your local system improvement efforts can be monitored for effect and specific wins celebrated by your change team, your system leaders and your clients.

*Your Health System (developed from the Canadian Hospital Reporting Project). Canadian Institutes for Health Information. Ottawa, Canada, 2015. https://www.cihi.ca/en/health-system-performance/your-health-system-tools

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