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We burden health systems and providers with an unsustainable number of required and recommended patient safety metrics.
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Reducing the Flood of Excessive Measurement

By Joellen Huebner | Tuesday, February 25, 2020

Is There an Antidote

It’s that time again. Your system’s Board of Directors will be meeting next month and, as usual, you’re tasked with preparing the regular patient safety presentation. You reluctantly sit down at your computer and the same questions you’ve always had resurface:

  • Why are we measuring so many things?
  • Are we measuring what matters to our patients? To our providers?
  • What are we even doing with all this data?

You’re stuck in a whirlwind of measures before you’ve even started. Can’t we do better?

The Cambridge Health Alliance, a public safety-net system headquartered in Cambridge, Massachusetts, recently surveyed their system and identified a total of 542 measures required by various payers and providers – for the ambulatory setting alone. In both the US and around the globe, we are burdening health systems and providers with an unsustainable number of required and recommended patient safety metrics. To make matters worse, many of these metrics are outdated, inpatient-focused, fail to incorporate the essential perspective of our patients, and allow only for retrospective analysis. While we’re unlikely to identify a single measure for total system safety, health care needs a thoughtfully designed set or system of measurement capable of assessing the safety of patients throughout their health journeys.


Principles for Improving Patient Safety Measurement Virtual Learning Hour | March 10


With this goal (and more than a little frustration with the current system) in mind, the IHI Lucian Leape Institute convened more than 40 thought leaders and stakeholders from around the globe for a five-day Salzburg Seminar on patient safety measurement. The group reviewed the attributes of current measurement systems around the globe and brainstormed opportunities for coordinated improvement. As a starting point, they distilled these robust conversations into the following critical principles for the global measurement of patient safety:

  • The purpose of measurement is to collect and disseminate knowledge that results in action and improvement.
  • Effective measurement requires the full involvement of patients, families, and communities within and across the health system.
  • Safety measurement must advance equity.
  • Selected measures must illuminate an integrated view of the health system across the continuum of care and the entire trajectory of the patient’s health journey.
  • Data should be collected and analyzed in real time to proactively identify and prevent harm as often as possible.
  • Measurement systems, evidence, and practices must continuously evolve and adapt.
  • The burden of measures collected and analyzed must be reduced.
  • Stakeholders must intentionally foster a culture that is safe and just to fully optimize the value of measurement.

You lean back in your chair, imagining a world in which you’re only required to collect meaningful metrics and could collaborate (and compare data) with other organizations.

A calendar notification — a reminder of the looming deadline for board materials — pulls you back to the task at hand. You wonder how to create this alternate reality.

Are you ready to take steps toward change in your organization right now? Consider completing an inventory of all the existing safety and quality measures at your organization. Ask two questions about each measure:

  1. Who is responsible for the collection of this measure? The analysis?
  2. What is the purpose of this measure? How are we currently using the data?

Share your thoughts (and dreams!) about the future of patient safety measurement in the comments below or connect with IHI Senior Project Manager Joellen Huebner at jhuebner@ihi.org.

Joellen Huebner is an IHI Senior Project Manager.

Editor’s note: IHI is continuing to develop tools, resources, and recommendations for the future of patient safety measurement. Upcoming opportunities to connect with IHI include:

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