What are indicators and how to set them?
In the clinical evaluation field, specifically for health care, an indicator in an instrument used to measure or assess specifici aspects of quality of care, and ultimately, the improvement of quality: assessment to improve.
The methodology used for creating or developing health indicators is distinct in that it combines different methodologies. In the first place, when elaborating indicators, the standard and most recommended procedure is to begin with a conceptual framework of reference, as this provides the premise for reflecting aspects of assessment, dimension, attributes, key areas of care specific to the field of study, as well as the target population. Moreover, the process of defining indicators takes into consideration two sources: scientific evidence experience and expert opinion.
A literature review enables authors to take into consideration scientific evidence and experience in the use of the indicator. A review of the scientific evidence ensures the validity of both the construct, (the indicator measures the intended target), as well as the guidelines (there is close correlation between an indicator and the outcome or another measure considered the gold standard). In addition, previous experience in the application of an indicator provides some basis as to its acceptability or use thereof. Generally, users find an indicator helpful if variations in the values it presents are due to changes in the quality of care, and vice versa.
As far as expert opinion is concerned, it is important to highlight the advantages to using consensus methods during the process of identification and selection of indicators, a highly participative course of action. In general, the process is based on a consensus-centred approach (i.e., a group of professional experts which may, in addition, incorporate opinions from a group of patients and users), which is subsequently extended to a larger body of associated groups. Thus, the involvement of a significant number of participants in reaching a consensus on indicators reinforces the embeddedness of the assessment strategy and collective responsibility, furthering the eventual adoption and implementation of the indicators.
Figure 1. Combination of methodologies for developing indicators
How to implement indicators?
Once the indicators have been defined, there are several different approaches to their implementation. These include performance analysis and comparison between units of analysis, or benchmarking, whether this refers to organizations, centres, services, teams or professionals. The first approach seeks to analyse the relationship between health outcomes (in quantity and quality) and the resources utilized, in other words, the value of health care. The objective is to identify the gap between what might be achieved using existing technology and resources (efficiency, the maximum achievable potential), and what is actually being achieved (effectiveness), adjusted due to the available resources and other variables which impact the outcome.
Figure 2. An example of mapping indicators used to analyse performance. In this case, the graph maps the ratio of observed/expected cases for the indicator subject to the study for Basic Healthcare Areas (ABS, as per the Catalan acronym).
Finally, if the process is taken to the next level, we find ourselves in the realms of benchmarking, which allows us to make a comparative assessment. Basically, this involves using any product, service or work process within an organisation and which manifest best practises in the area of interest and using it as “comparator” or benchmark. The objective of this process is to transmit information regarding best practices and their implementation.
Figure 3. Sample mapping of an indicator used to make comparisons between units of analysis (benchmarking)
Post written by Mireia Espallargues, Noemí Robles and Laia Domingo.