As part of the quality improvement process, data is needed to identify a baseline current state, determine gaps, and track progress towards a target rate. Dashboards are one way to display these components and enable a picture of current performance. Think of dashboards as performance monitoring systems, similar to an automobile dashboard that provides real-time information on current status of fuel, temperature, speed, and various engine components.
Advantages include the following: providing close to or actual real-time information, the ability to drill down to patient-specific information, benchmarking against like size facilities or similar level of care designations, and comparison to national standards or established targets. Color coding is often used to provide a quick visual on areas doing well and those in need of improvement, typically red, yellow, and green. Users can easily identify when performance begins to drift, informing changes to correct problems before they snowball into bigger issues (Sprague, et.al 2013). In addition, placing dashboards in clinical areas promotes transparency and engagement of front-line staff. It also provides a way to bridge the gap between best practice and the bedside.
Case Example
Sprague et.al. (2013) described the development of a maternal newborn dashboard on select clinical performance indicators in all hospitals providing maternal-newborn care in Ontario, Canada. The purpose of the dashboard was to provide a way to provide data feedback on performance to hospitals and health care providers in this province. Benchmarks were established based on literature review, current practice, and project members’ clinical expertise.
Hospitals in this program had a process in place for submitting their data which then populated their dashboard. In addition, the dashboard had the capability of drilling down to individual patient information to allow for a deep dive on cases and the identification of gaps. Individual hospital dashboards consisted of key performance indicators with the reporting hospital individual rate, current status, status range, comparison to hospitals with the same level of care and similar volumes, and rates for all reporting hospitals within the database as a whole.
Dashboard Examples
See below for several dashboard examples. Please note the target benchmark numbers are for example only and not based on literature reference. Examples are adapted with a similar format from the maternal newborn dashboard in the article by Reszal et.al. (2019).
Example 1
Example 2
In summary, dashboards are visual tools used to display data in real-time. They act as an early warning system, flagging users to metric changes that would warrant corrective actions to mitigate potential patient harm.
References
Reszel, J., Dunn, S. I., Sprague, A. E., Graham, I. D., Grimshaw, J. M., Peterson, W. E., . . . Walker, M. C. (2019). Use of a maternal newborn audit and feedback system in Ontario: A collective case study. BMJ Quality & Safety, 28(8), 635-644. doi:10.1136/bmjqs-2018-008354
Sprague, A. E., Dunn, S. I., Fell, D. B., Harrold, J., Walker, M. C., Kelly, S., & Smith, G. N. (2013). Measuring Quality in Maternal-Newborn Care: Developing a Clinical Dashboard. Journal of Obstetrics and Gynaecology Canada, 35(1), 29-38. doi:10.1016/s1701-2163(15)31045-8
Weiss, D., Dunn, S. I., Sprague, A. E., Fell, D. B., Grimshaw, J. M., Darling, E., . . . Taljaard, M. (2017). Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: An interrupted time-series study. BMJ Quality & Safety, 27(6), 425-436. doi:10.1136/bmjqs-2017-007361
Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS