Abstract
BackgroundDashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation.ObjectiveThis paper reports the findings of a realist evaluation of a web-based quality dashboard (QualDash) developed to support the use of national audit data in quality improvement.MethodsQualDash was co-designed with data users and installed in 8 clinical services (3 pediatric intensive care units and 5 cardiology services) across 5 health care organizations (sites A-E) in England between July and December 2019. Champions were identified to support adoption. Data to evaluate QualDash were collected between July 2019 and August 2021 and consisted of 148.5 hours of observations including hospital wards and clinical governance meetings, log files that captured the extent of use of QualDash over 12 months, and a questionnaire designed to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analyzed to understand how, why, and in what circumstances QualDash supported the use of national audit data in quality improvement.ResultsThe observations revealed that variation across sites in the amount and type of resources available to support data use, alongside staff interactions with QualDash, shaped its use and impact. Sites resourced with skilled audit support staff and established reporting systems (sites A and C) continued to use existing processes to report data. A number of constraints influenced use of QualDash in these sites including that some dashboard metrics were not configured in line with user expectations and staff were not fully aware how QualDash could be used to facilitate their work. In less well-resourced services, QualDash automated parts of their reporting process, streamlining the work of audit support staff (site B), and, in some cases, highlighted issues with data completeness that the service worked to address (site E). Questionnaire responses received from 23 participants indicated that QualDash was perceived as useful and easy to use despite its variable use in practice.ConclusionsWeb-based dashboards have the potential to support data-driven improvement, providing access to visualizations that can help users address key questions about care quality. Findings from this study point to ways in which dashboard design might be improved to optimize use and impact in different contexts; this includes using data meaningful to stakeholders in the co-design process and actively engaging staff knowledgeable about current data use and routines in the scrutiny of the dashboard metrics and functions. In addition, consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and consequently its potential to stimulate quality improvement.International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-033208
Highlights
BackgroundHealth care organizations are complex systems with variations in patient care and outcomes observed nationally and internationally [1,2]
Consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and its potential to stimulate quality improvement
We begin with a summary of the care quality monitoring routines observed, and to refine the CMOcs in Multimedia Appendix 1, explore how, why, and to what extent the dashboard impacted practice by facilitating reporting (CMOc 1) or integrating national audit data in routine practices (CMOc 2)
Summary
BackgroundHealth care organizations are complex systems with variations in patient care and outcomes observed nationally and internationally [1,2]. Audit and feedback may help reduce variations in care quality by comparing clinical performance against standards and benchmarks to stimulate data-driven improvement [3]. In the National Health Service (NHS) in England, national audit and feedback are part of a well-established quality improvement program that encompasses over 50 clinical specialties and patient groups [4,5]. Audit suppliers centrally collate and manage data from participating services and produce feedback, with national comparators, with the intention of stimulating quality improvement [6]. Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation
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