Measurement and quality improvement

Data to support safety and quality improvement 

Measurement and feedback are key to quality improvement. Data are fundamental to measurement and can be used to identify areas where a healthcare service is doing well and areas where improvement is required. At a healthcare service level, data that can be used to inform measurement for quality improvement may include:

• Data relating to types of services provided
• Patient information, such as the number of appointments over a period of time, reasons for seeking advice/treatment, improvements in health outcomes over time 
• Feedback from patients including experiences, compliments and complaints
• Information collected from the workforce about their experiences 
• Incidents, near misses and adverse events
• Attendance and appointment data, patient enquiries or community demographics, or other data that is relevant to the healthcare service. Some healthcare services may be required to collect data as part of a contract or agreement, which may also be used to identify safety and quality improvement priorities.

Relevant data will differ between healthcare services and will depend on the safety and quality priorities identified. No single measure should be used in isolation to assess the safety and quality of a healthcare service. Instead, a comprehensive measurement and improvement system should be adopted. 

Validated indicators, measurement and reporting tools 

The Commission undertakes a range of projects to support the meaningful use of data to improve patient care and is working to develop tools and resources that support healthcare services to use data for quality improvement. 

National Primary Healthcare Data 

The Australian Institute for Health and Welfare (AIHW) is leading the development of a Primary Health Care Information System, including the development of a National Primary Health Care Data Asset, to gain a better understanding of a patient’s journey and experiences within the primary healthcare system.^[i],[ii] This work will help fill existing aggregate primary healthcare data gaps at regional and national levels, to enable identification of trends and priorities for safety and quality improvement. 

In addition, data provided to Primary Health Networks can be used to inform service and system planning at local and regional levels.

• What data does your healthcare service use to identify areas for improvement? 
• What changes have been made in your healthcare service as a result of the review of data? 
• What impact, if any, have changes that have been implemented made? How was this impact measured? 
• How is information about your service’s safety and quality performance communicated to patients, carers and families and the workforce? 

• Identify and collect data within your healthcare service that can be used to inform the safety and quality improvement priorities for the service.
• Routinely review data collected to identify areas for improvement and take action to make continuous improvements.
• Measure changes in safety and quality outcomes as a result of improvements implemented.
• Communicate information of the service’s safety and quality to patients, carers and families and the workforce.

• The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:
• Data collected and reviewed to identify safety and quality improvements
• Examples of changes made within the healthcare service as a result of the review of data and improvements made 
• Examples of how information about your service’s safety and quality is communicated to patients, carers and families and the workforce, for example
  • certificates of safety and quality performance displayed in common service areas
  • information on notice board in workforce areas 
  • communication books or meeting records.

Commission resource

• Clinical Care Standards – recommended indicators and data sets within relevant clinical care standards, which aim to support implementation of quality standards for specific clinical conditions.

Other resources

• Australian Institute of Health and Welfare: Primary health care data development – information about the AIHW’s project that will encompass the governance, standards, infrastructure, collection, analysis and reporting of primary health care data within Australia. 
• BMJ Journals, quality and care: How safe is primary care? A systematic review – the review investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.
• Institute for Healthcare Improvement: Plan, Do, Study, Action (PDSA) Worksheet – a useful tool for documenting a test of change. 
• Pride in Health + Wellbeing: Getting Better Audit tool – a free tool to measure your healthcare service’s LGBTQI+ inclusion.
• South Eastern Melbourne Primary Health Network: Quality Improvement – an overview of key requirements and resources to support quality improvement
• World Health Organization: Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens – a conceptual framework for measuring primary health care performance at a health system level, including a menu of indicators to track and monitor progress, and identify gaps and areas for improvement.