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

Abstract

BackgroundThis 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.MethodsA 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.ResultsCommon 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.ConclusionThe 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.

COVID-19 Preparedness and Perceived Safety in Nursing Homes in Southern Portugal: A Cross-Sectional Survey-Based Study in the Initial Phases of the Pandemic

“…Contributing to this context could be the current levels of integration of health and social care information, which is uncoordinated and poor regarding data interoperability [26]. In the future, initiatives for collecting actionable performance intelligence [27] in a timely fashion should be outlined in a concerted manner, prioritizing those data that could inform context-specific decision-making [28], namely via actionable dashboards [29].…”

COVID-19 Preparedness and Perceived Safety in 138 Nursing Homes in Southern Portugal: A Cross-sectional Survey-based Study in the Initial Phases of the Pandemic

“…Contributing to this context could be the current health information landscape, which is often uncoordinated and poor regarding data interoperability [26]. In the future, initiatives for collecting actionable performance intelligence [27] in a timely fashion should be outlined in a concerted manner, prioritizing those data that could inform context-specific decision-making [28], namely via actionable dashboards [29].…”

Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)

“…68 Nevertheless, the reliability estimate provided is only relevant to compare practices at an aggregated level (meso-level) and therefore individual PSIs with low reliability could still be used to identify patients at risk of harm for improvement interventions at a patient level (microlevel) and also to assess the safety nationally or to compare it internationally (macro-level). 70 Several concerns and opportunities can be drawn from these findings, highlighting the need for further research into interventions to improve prescribing safety for patients with mental illness. Several studies have explored means to improve different aspects of medication safety issues for patients with mental illness, including: specialist mental health clinical pharmacy teams in primary care to improve medicine optimisation, 71 improved and greater collaboration between GPs and secondary care, 72 increased knowledge and skills training for managing mental illness in primary care 72 and better communication between GPs and psychiatrists to help improve metabolic monitoring for patients on antipsychotics.…”