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Dashboards: Leading Quality Indicators

02/11/2021

By K. Suresh Gautham, MD, DM, MS, FAAP 

When we drive every day, we look at the dashboard in our car. The car dashboard is an excellent example of how a few important indicators can be displayed visually in a format that is easily comprehensible to users. In contrast, the dashboard in an airplane cockpit consists of a large number of numeric displays, dials and gauges, and seems bewildering to the untrained person. 

In health care, it is important for leaders of units, departments, clinics and hospitals to select a few important quality indicators that inform them about the processes and outcomes of the care they provide, and display a parsimonious set of indicators graphically, in an easily comprehensible manner. 

An important feature of data dashboards—whether they are in a car, plane or hospital—is that the data displayed are in real-time (or close to real-time), rather than providing a retrospective look at system or individual performance. In other words, the dashboard should display ‘leading’ indicators and not ‘lagging’ indicators. 

Data Dashboard to Monitor Use of Restraints
The article, “A Visual Dashboard to Monitor Restraint Use in Hospitalized Psychiatry Patients,” in the upcoming May 2021 issue of The Joint Commission Journal on Quality and Patient Safety, describes how a data dashboard was developed and implemented to monitor the use of restraints in multiple inpatient units within one institution. The use of restraints in inpatient psychiatry units is an important quality indicator that is required to be reported to national bodies. 

The authors, Luming Li, MD, and Todd Barnes, MPH, BSN, RN, CPHQ, developed the following process:

  • orders for the use of restraints were entered by physicians, nurse practitioners or physician assistants into the electronic medical record
  • actual initiation and discontinuation of restraint use was documented by nurses
  • data were deposited into the institution’s electronic data warehouse
  • data were automatically exported to a commercial data display tool and updated every 24 hours 

When creating a dashboard, the authors recommend asking these questions:

  • What indicators should be displayed?
  • How should the data be analyzed, stratified and displayed?
  • Where should the dashboard be displayed?
  • Who should be able to view the data?

While they do not report any patient outcomes or process measures, this article provides an excellent example of how other units, working in collaboration with their Information Technology department, can also develop unit-specific dashboards for key quality measures. 

The article also adds to the small number of existing publications about the use of quality dashboards in health care. Such dashboards should be used more widely as they:

  • enhance routine monitoring of important quality indicators and system performance
  • provide early detection of deviations from ideal care, inter-institutional or inter-unit differences
  • identify responses to policy changes and quality improvement interventions

With the widespread use of electronic medical records, most hospitals and clinics are sitting on a pile of patient data that is untapped and that, if accessed and analyzed well, can provide great insights into system performance and eventually form the basis for improvement. One day, ideally, every health care unit, like every car, will have a dashboard. 

K. Suresh Gautham, MD, DM, MS, FAAP, is deputy editor for The Joint Commission Journal on Quality and Patient Safety, senior editor of the Neonatal Review Group of the Cochrane Collaboration and professor of pediatrics at Baylor College of Medicine, Houston.