Improvement needs measurement. End of.

By Beth Cooper, November 24, 2016

Some decades ago, a model for the improvement of systems emerged and gained support in the field of healthcare. It is remarkably simple: a cycle – plan, do, study, act (or PDSA), and despite its origins, it remains an effective model for any organisation wanting to change something.

The reason it is so effective is that the model gives weight to all stages of the cycle. It doesn’t stop after the ‘planning’ and the ‘doing’ but moves on to a reflection upon the effectiveness of the change in a ‘study’ phase which, by highlighting what works and what doesn’t, allows another iteration of the change to be made. It’s a change process with learning built in, and that is what drives the improvement.

Those who believe that we have, culturally, become too fond of measurement would cite the old saying that you don’t fatten a pig by weighing it. There is truth in that. But it’s also true that you can overfeed a pig and push its price down instead of up. If you’re rearing pigs for pork, you don’t want them overfat. The right approach is to feed the pig and monitor its weight gain.

Metrics matter and they matter in farming, in healthcare and in the implementation of new software systems. Measurement doesn’t result in an improvement – not on its own. It’s what you do with the knowledge that makes the difference.

Imagine the implementation of a new, computerised system for staff appraisals. In this scenario, participation is encouraged but is voluntary. Initially, the number of staff trying the new application is high, but few complete the process. Soon, negative feedback from the early users causes a slowdown in the uptake and the ultimate failure of the project.

Measurement of the process would have highlighted the places where users lost focus, interest, or began to struggle with the application. It wouldn’t have stopped the user quitting the system, but it would have shown up the areas that needed changing. Going back to the PDSA model, an action could have been put in place to prevent the project failure.

Measurement is too often seen as a tool for reward and recognition – this is good, this is bad, you win, you lose – but it is much more than that. It’s how you know whether a change is beneficial, how you begin to understand the causes of success and failure, and ultimately, how you know you’re going in the right direction.