What tool to measure quality improvement and patient safety in a large Italian Academic Hospital?

Issue: Indicators are key tools to establish the current status of an healthcare system, to recognize issues, to quantify reasonably pursuable goals in a given time frame, to verify consistency between obtained and expected results, to identify areas needing corrective actions and to measure the impact of activities carried out. Healthcare systems generate huge amounts of data that offers considerable potential for policymakers, healthcare professionals, and patients if gathered and used appropriately. However, in most hospitals the collection, organisation and deployment of data is not effectively set up and used. In 2012 a retrospective study on a large Italian Academic Hospital (AH) data flows revealed a high number of indicators (N = 398), with only 33.6% related to Quality Improvement and Patient Safety (QIPS). It was urgent to prioritize which QIPS processes to measure and to create a key performance indicators set (KPIS). Results: In 2013 AH leadership defined a QIPS policy structured in four chapters: 1. quality planning process 2. methods and tools employed to collect, analyze and validate data, used to identify appropriate indicators 3. recipients of the monitoring findings 4. data sharing systems. It was created a specific indicator format report according Joint Commission Accreditation recommendations. In 2013 and 2014, each AH operative units were asked to select an evidence based clinical practice and to measure its adoption through an outcome indicator monitored quarterly. All indicators (80 in 2013, 55 in 2014) were collected in an annual ‘Indicators Handbook’ delivered in AH intranet. Lessons: The efforts which were invested by leadership in creating a KPIS, shared with clinicians, represent the basis of the measurement used to analyse hospital performances. This study stresses the concept that a KPIS is a tool which evaluates how an hospital executes its strategic vision.