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Measuring Improvement and Communicating with Colleagues

Up to Communities of Practice - what are they and why are they important?
August 06. 2018
Jody Deacon

Measurements for Improvement

What can we learn about health improvement and communication from a banana and a piece of string?

After attending a recent Measurement for Improvement workshop run by NHSI and the AHSN,  I found this exercise an enlightening one.  It is something that has stuck with me as a reminder of how we can best work collaboratively.

The task was to measure a banana.  Then instruct others on how to do it.

We were split into 4 groups, on 4 different tables.  We all had one banana, a piece of string, a ruler, sheet of paper and pen.  The task was not only to measure the banana, but to also relay instructions on 'how' we had measured 'our' banana. 

Then we would pass our banana forward to the next table.  They would have to measure our banana according to our instructions and of course we would also receive a different banana, to be measured according to another tables instructions. 

A simple task you might think.

The task was surprisingly quite a long one, but the punchline worth it I feel.  All tables, measured all 4 bananas, using the 4 somewhat surprisingly different methodologies.

Being as these were plastic banana's, I could see my fellow audience thinking to themselves - 'Really, we have to measure all 4?  Is there any point to that?'

Indeed there was a point to taking the time to do complete the exercise in full. 

It turns out that, yes all the bananas were one standard size, however the measured results were not.  Neither were the developed instructions on how to measure - results and methods varied greatly. 

Some tables made use of the string and calculated the entire banana length and circumference, other tables only measured length.  Some tables measured tip to branch on the inside, others measured the outside. 

On writing the instructions some tables drew diagrams, others used bullet points.  Some instructions were detailed, others were not so.   Some instructions included the units of measure, some did not include any criteria.  Some made use of all the available equipment and some instructions failed to be clear or defined. 

When compared, the results as already mentioned varied widely.  Colleagues had not understood instructions provided by other tables, or interpreted them differently.

The exercise involved simple plastic bananas (all the same size by the way!), simple measuring equipment, and a small amount of people through which to translate instructions on what to achieve. 

It served to show how difficult it is to a) measure anything and b) ask others to measures items on your behalf.

How can we improve then?

When looking at what you want to measure, why and how, much more thought needs to be given if you are asking others to do the measuring on your behalf.

The exercise provided a moment of revelation. 

We may think we have been clear on our reasons and methodologies, but have we really? 

  1. Take the time to think about why you need to measure something, list the rationale or the benefits, should you be capturing data for any reason or a specific purpose?
  2. Think what exactly it is you need to measure, take time to define the criteria and make sure you work with colleagues to see if it is understood, is it a broad or narrow focus for instance?
  3. Think about how it can be measured and plan out the instructions, will these be understood by those you are asking to take the measurements? 
  4. Improvement is usually measured over a period of time - improvement is not a direct comparison, or snap shot.
  5. Improvement requires 'real' numbers, averages will not help you measure improvement.

If anyone else has any learnings on either communities of practice, measuring improvement or communication, please do let us know. 

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