Balancing measures or a balanced accounting of improvement impact: a qualitative analysis of individual and focus group interviews with improvement experts in Scotland

Abstract

Improvement measurement is usually focused on measuring intended , with minimal use of balancing measures which when used, typically monitor expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any or

Improving the quality of care for patients with or at risk of atrial fibrillation: an improvement initiative in UK general practices

“…To understand whether efforts to increase AF diagnosis through screening inadvertently reached a subpopulation less at risk of stroke or bleeding than others, we measured the average CHA 2 DS 2 -VASc and HAS-BLED scores among patients newly diagnosed with AF. These measures acted as ‘balancing measures’ 20…”

Balancing Measures When Restricting Laboratory Testing

“…Evaluating pleasant or unpleasant surprises (balancing measures) is essential across the life of an improvement program. 3 We are inspired by the work of MacMillan and colleagues and hope to replicate these results at our institute.…”

Are increases in emergency use and hospitalisation always a bad thing? Reflections on unintended consequences and apparent backfires

“…Peltzman probably overestimated so-called 'compensatory risk' in the specific case of automobile safety regulations, but other documented examples exist. Compensatory risk may also explain why injuries exact a heavier toll in American football than they do in rugby, despite football players wearing protective equipment, playing shorter games and tackling less 13 Efforts to reduce hospital length of stay might increase short-term readmissions.…”

“…Unintended conseqUences in qUality improvement: From the predictaBle to the perverse Quality improvement reports often use 'balancing measures' 13 to monitor predictable unintended consequences-for instance, tracking readmission rates in a project aimed at reducing length of stay (table 2). The literature on unintended consequences of performance measures constitutes a genre in itself, [14][15][16][17] with many examples of Goodhart's law-when a measure becomes a target, it ceases to be a good measure.…”