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Exploring the actionability of healthcare performance indicators for quality of care: A qualitative analysis of the literature, expert opinion and user experience. / Barbazza, Erica; Klazinga, Niek S.; Kringos, Dionne S.

In: BMJ quality & safety, Vol. 30, No. 12, 01.12.2021, p. 1010-1020.

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@article{3378287bc1f643d7ba1e871e7ef40799,
title = "Exploring the actionability of healthcare performance indicators for quality of care: A qualitative analysis of the literature, expert opinion and user experience",
abstract = "Background: This study explores the meaning of actionable healthcare performance indicators for quality of care-related decisions. To do so, we analyse the constructs of fitness for purpose and fitness for use across healthcare systems and in practice based on the literature, expert opinion and user experience. Methods: A multiphase qualitative study was undertaken. Phases included a literature review, a first round of one-on-one interviews with a panel of academics and thought leaders in the field (n=16), and a second round of interviews with real-world users of performance indicators (n=16). Thematic analysis was conducted between phases in order to triangulate findings in a stepwise process. Results: Common uses of healthcare performance indicators were differentiated within micro-meso-macro contexts of healthcare systems. Each purpose of use signals different decision-making tasks, and in effect information needs. An indicator's fitness for use can be appraised by three clusters of considerations: methodological, contextual and managerial. Methodological considerations gauge an indicator's perceived importance, engagement potential, interpretability, standardisation, feasibility of remedial actions, alignment to care models and sensitivity to change. Information infrastructure, system governance, workforce capacity and learning culture were found as enabling contextual considerations. Managerial considerations influencing an indicator's use in practice were found to span the selection of indicators, data collection, analysis, display of results and delivery of information to decision-makers. Conclusion: The actionability of a healthcare performance indicator should be appraised by its alignment with the intended purpose of use beyond aggregate healthcare system levels, in combination with the extent to which methodological, contextual and managerial fitness for use considerations are met. Striking a better balance between the importance weighted to an indicator's statistical merits and emphasis put to its fitness for purpose and use is needed for indicators that are ultimately actionable for quality of care-related decision-making.",
keywords = "health services research, healthcare quality improvement, management, performance measures, quality measurement",
author = "Erica Barbazza and Klazinga, {Niek S.} and Kringos, {Dionne S.}",
note = "Funding Information: Funding This study was funded by H2020 Marie Sk{\l}odowska- Publisher Copyright: {\textcopyright} 2021 BMJ Publishing Group. All rights reserved.",
year = "2021",
month = dec,
day = "1",
doi = "10.1136/bmjqs-2020-011247",
language = "English",
volume = "30",
pages = "1010--1020",
journal = "BMJ quality & safety",
issn = "2044-5415",
publisher = "BMJ Publishing Group",
number = "12",

}

RIS

TY - JOUR

T1 - Exploring the actionability of healthcare performance indicators for quality of care: A qualitative analysis of the literature, expert opinion and user experience

AU - Barbazza, Erica

AU - Klazinga, Niek S.

AU - Kringos, Dionne S.

N1 - Funding Information: Funding This study was funded by H2020 Marie Skłodowska- Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - Background: This study explores the meaning of actionable healthcare performance indicators for quality of care-related decisions. To do so, we analyse the constructs of fitness for purpose and fitness for use across healthcare systems and in practice based on the literature, expert opinion and user experience. Methods: A multiphase qualitative study was undertaken. Phases included a literature review, a first round of one-on-one interviews with a panel of academics and thought leaders in the field (n=16), and a second round of interviews with real-world users of performance indicators (n=16). Thematic analysis was conducted between phases in order to triangulate findings in a stepwise process. Results: Common uses of healthcare performance indicators were differentiated within micro-meso-macro contexts of healthcare systems. Each purpose of use signals different decision-making tasks, and in effect information needs. An indicator's fitness for use can be appraised by three clusters of considerations: methodological, contextual and managerial. Methodological considerations gauge an indicator's perceived importance, engagement potential, interpretability, standardisation, feasibility of remedial actions, alignment to care models and sensitivity to change. Information infrastructure, system governance, workforce capacity and learning culture were found as enabling contextual considerations. Managerial considerations influencing an indicator's use in practice were found to span the selection of indicators, data collection, analysis, display of results and delivery of information to decision-makers. Conclusion: The actionability of a healthcare performance indicator should be appraised by its alignment with the intended purpose of use beyond aggregate healthcare system levels, in combination with the extent to which methodological, contextual and managerial fitness for use considerations are met. Striking a better balance between the importance weighted to an indicator's statistical merits and emphasis put to its fitness for purpose and use is needed for indicators that are ultimately actionable for quality of care-related decision-making.

AB - Background: This study explores the meaning of actionable healthcare performance indicators for quality of care-related decisions. To do so, we analyse the constructs of fitness for purpose and fitness for use across healthcare systems and in practice based on the literature, expert opinion and user experience. Methods: A multiphase qualitative study was undertaken. Phases included a literature review, a first round of one-on-one interviews with a panel of academics and thought leaders in the field (n=16), and a second round of interviews with real-world users of performance indicators (n=16). Thematic analysis was conducted between phases in order to triangulate findings in a stepwise process. Results: Common uses of healthcare performance indicators were differentiated within micro-meso-macro contexts of healthcare systems. Each purpose of use signals different decision-making tasks, and in effect information needs. An indicator's fitness for use can be appraised by three clusters of considerations: methodological, contextual and managerial. Methodological considerations gauge an indicator's perceived importance, engagement potential, interpretability, standardisation, feasibility of remedial actions, alignment to care models and sensitivity to change. Information infrastructure, system governance, workforce capacity and learning culture were found as enabling contextual considerations. Managerial considerations influencing an indicator's use in practice were found to span the selection of indicators, data collection, analysis, display of results and delivery of information to decision-makers. Conclusion: The actionability of a healthcare performance indicator should be appraised by its alignment with the intended purpose of use beyond aggregate healthcare system levels, in combination with the extent to which methodological, contextual and managerial fitness for use considerations are met. Striking a better balance between the importance weighted to an indicator's statistical merits and emphasis put to its fitness for purpose and use is needed for indicators that are ultimately actionable for quality of care-related decision-making.

KW - health services research

KW - healthcare quality improvement

KW - management

KW - performance measures

KW - quality measurement

UR - http://www.scopus.com/inward/record.url?scp=85105888852&partnerID=8YFLogxK

U2 - 10.1136/bmjqs-2020-011247

DO - 10.1136/bmjqs-2020-011247

M3 - Review article

C2 - 33963072

VL - 30

SP - 1010

EP - 1020

JO - BMJ quality & safety

JF - BMJ quality & safety

SN - 2044-5415

IS - 12

ER -

ID: 18246046