Why Process Measures Are Often More Important Than Outcome Measures in Healthcare

Why Process Measures
Are Often More Important
Than Outcome Measures
in Healthcare
-Tom Burton

© 2014 Health Catalyst
www.healthcatalyst.com
Measuring Outcomes
Tracking outcome measures
alone is insufficient to achieve
quality and cost goals.
Health systems must get more
granular with their data. In
addition to outcome measure-ments
they must also track
evidence-based process
measures.
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1 2
Three Measures
Here are the three types
of measures we use in
healthcare analytics:
PROCESS
3
1- Outcome Measure
2- Balance Measure
3- Process Measure

Three Measures
Outcome measures are
high-level clinical or financial
outcomes.
These measures are often
reported to government and
commercial payers. Some
examples of metrics for
outcome measures include
mortality rates, readmissions
rates, and surgical site
infection rates.
OUTCOME
MEASURE

Three Measures
Balance measures are
metrics a health system must
track to ensure improvement in
one area does not negatively
impact another.
For example, let’s say length of
stay (LOS) is the outcome metric.
The balance metric might be
patient satisfaction. If the patient
feels rushed they may lower the
satisfaction score even while
improving LOS.
BALANCE
MEASURE

Three Measures
Process measures are the
specific steps in a process that
lead — either positively or
negatively — to a particular
outcome metric.
Looking at the LOS metric you
might determine that a lengthy
delay in pharmacy delivery
impacts the discharge event.
You’ve pinpointed a concrete
opportunity for healthcare
process improvement.
PROCESS
MEASURE

Importance of Process Measures
Process measures represent a
health system’s efforts to
incorporate and systematize
evidence-based best practices
into its improvement efforts.
One goal is to identify at-risk
patients for the treatment
process you are analyzing.

Let’s look at a patient injury
prevention example—bedsores.
The incidents of bedsores is
your outcome measure. You
know your baseline rate, and
you want to reduce it, but how
are you actually going to drive
improvement?

The answer is straightforward:
by implementing and tracking
the right process metrics.
Process measures in this
example are the steps that
should be performed every time
for every bed-bound patient in
the intensive care unit (ICU) or
in the med-surg units.

First you would perform a risk
assessment using the Braden
Scale for predicting pressure
ulcer risk on all the appropriate
units in the Hospital.
Patients identified as “at risk”
would then receive treatment for
preventing bedsores according
to your organization’s chosen
best-practice protocol.

For example, you might set up
protocols for reassessment,
nutrition, lifting and repositioning
the patient, providing a special
mattress, and skin care.
The important thing is that each
of these steps in the process
can be can be tracked and
measured. Over time you will
begin to identify which process
steps are the most important for
preventing negative outcomes.

One of the greatest benefits
of having this process metric
data on hand is the ability to
identify root causes.
The problem does not stem
from your people. It stems
from your process.
Often, many borderline cases go unreported because of
the lack of a culture based on a learning environment and
too much focus on outcomes metrics.
Determining Root Cause

Every system is perfectly designed
to get the results it gets.”
— Paul Batalden, MD
If you don’t have a well-designed
process in place to prevent
pressure ulcers, it should be no
surprise if you don’t perform well
on that outcome metric.

By tracking process measures,
you can pinpoint the root
cause of the system’s failure.
Many process issues could be
behind the pressure ulcer
problem.
Shortage of pressure-redistributing mattresses
Failed to do solid patient risk assessment
Skincare product unavailable when needed

Using Measures to Reduce Variation
Process measures improve
quality and cost by enabling
organizations to reduce the
amount of variation in care
delivery.
Establishing process metrics at
potential points of variation in a
care process enables you to
monitor and reduce
inappropriate variation.

Using Measures to Reduce Variation
A value stream map
outlines the steps in a process
that deliver value to a patient.
Each step may have a process
measure useful in measuring
process consistency. By
measuring these steps, you
can find points of variation.
It’s possible to standardize processes so that all patients
consistently receive the highest-quality care at the lowest
possible cost regardless of which unit, which hospital or
which clinic they are visiting.
Value Stream Map

Use an EDW to Track Metrics
Healthcare organizations
normally don’t have the
infrastructure to handle both
outcome and process
metrics.
If they only have the
resources to track one of
these, they’ll choose
outcome metrics, because
those are the measures that
must be submitted to
Centers for Medicare and
Medicaid Services (CMS).

The reason organizations
struggle to track both types of
measures is because their
analytics methodologies rely
too much on manual work.
When you don’t have the right
technology infrastructure in
place to automate extraction
and distribution of data, you
end up having to do it manually. MANUAL
HUMAN
ERRORS
PROCESS

That’s where an enterprise
data warehouse (EDW) with a
robust, flexible analytics
architecture comes in.
An EDW eliminates manual
processes and forms the
foundation for healthcare
analytics by bringing all health
system data into a single
source of organizational truth. ENTERPRISE
DATA
WAREHOUSE

With an EDW, analysts can
focus their time on discovering
data patterns which will lead to
understanding, insight, and
ultimately action.
But without an EDW, it will be
very difficult for analysts to
provide reliable and
repeatable reports and in-depth
analyses of areas that
will provide the best
opportunities for improving
outcomes.

Link to original article for a more in-depth discussion.
Why Process Measures Are Often More Important Than Outcome
Measures in Healthcare
The Key to Real Process Improvement Outcomes: Linking Clinical and Financial Data
Bobbi Brown, VP of Financial Engagement
6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare
Bobbi Brown, VP of Financial Engagement
How to Reduce Sepsis Mortality Rates by 22% with Clinical and Process Improvement
Services — A Success Story from MultiCare Health System
More about this topic
The Best Approach to Healthcare Analytics
Tom Burton, Co-Founder, Senior VP of Product Development
Healthcare Analytics Adoption Model: A Framework and Roadmap (white paper)
David Burton, MD, SVP; Dale Sanders, SVP; and Denis Protti, ScD

For more information:

Other Clinical Quality Improvement Resources
Mr. Tom Burton is a co-founder of Health Catalyst and former President
of the company. He brings 14 years of process improvement and IT
experience to the company. Mr. Burton was a member of the team that
led Intermountain Healthcare's nationally recognized improvements in
quality of care delivery and reductions in cost. He has taught courses in
the Toyota Production System, Agile Software Development and currently teaches in
the Advanced Training Program at Intermountain Healthcare's Institute for Health
Care Delivery Research. Mr. Burton holds an MBA and a BS in Computer Science
from BYU.
Click to read additional information at www.healthcatalyst.com

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