Analysis of a Web-Based Dashboard to Support the Use of National Audit Data in Quality Improvement: Realist Evaluation

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. This paper reports the findings of a realist evalua...

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Published in:Journal of medical Internet research Vol. 23; no. 11; p. e28854
Main Authors: Alvarado, Natasha, McVey, Lynn, Elshehaly, Mai, Greenhalgh, Joanne, Dowding, Dawn, Ruddle, Roy, Gale, Chris P, Mamas, Mamas, Doherty, Patrick, West, Robert, Feltbower, Richard, Randell, Rebecca
Format: Journal Article
Language:English
Published: Canada Gunther Eysenbach MD MPH, Associate Professor 23.11.2021
JMIR Publications
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ISSN:1438-8871, 1439-4456, 1438-8871
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Abstract 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. This 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. QualDash 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. The 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. Web-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. RR2-10.1136/bmjopen-2019-033208.
AbstractList 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
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.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.This 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.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.QualDash 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.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.The 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.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.Web-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.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.RR2-10.1136/bmjopen-2019-033208.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)RR2-10.1136/bmjopen-2019-033208.
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. This 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. QualDash 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. The 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. Web-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. RR2-10.1136/bmjopen-2019-033208.
Background: 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. Objective: This 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. Methods: QualDash 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. Results: The 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. Conclusions: Web-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
Author Elshehaly, Mai
Greenhalgh, Joanne
Dowding, Dawn
Feltbower, Richard
Mamas, Mamas
Ruddle, Roy
Gale, Chris P
McVey, Lynn
Doherty, Patrick
West, Robert
Alvarado, Natasha
Randell, Rebecca
AuthorAffiliation 9 Department of Cardiology Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
12 Leeds Institute of Health Sciences University of Leeds Leeds United Kingdom
10 Keele Cardiovascular Group School of Medicine Keele University Keele United Kingdom
8 Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds United Kingdom
2 Wolfson Centre for Applied Health Research Bradford United Kingdom
7 Leeds Institute for Data Analytics Leeds United Kingdom
13 School of Medicine University of Leeds Leeds United Kingdom
3 Faculty of Engineering and Informatics University of Bradford Bradford United Kingdom
4 School of Sociology and Social Policy University of Leeds Leeds United Kingdom
5 School of Health Sciences University of Manchester Manchester United Kingdom
1 Faculty of Health Studies University of Bradford Bradford United Kingdom
6 School of Computing University of Leeds Leeds United Kingdom
11 Department of Health Sciences University of York York United Kingdom
AuthorAffiliation_xml – name: 8 Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds United Kingdom
– name: 1 Faculty of Health Studies University of Bradford Bradford United Kingdom
– name: 12 Leeds Institute of Health Sciences University of Leeds Leeds United Kingdom
– name: 4 School of Sociology and Social Policy University of Leeds Leeds United Kingdom
– name: 5 School of Health Sciences University of Manchester Manchester United Kingdom
– name: 10 Keele Cardiovascular Group School of Medicine Keele University Keele United Kingdom
– name: 2 Wolfson Centre for Applied Health Research Bradford United Kingdom
– name: 11 Department of Health Sciences University of York York United Kingdom
– name: 6 School of Computing University of Leeds Leeds United Kingdom
– name: 13 School of Medicine University of Leeds Leeds United Kingdom
– name: 3 Faculty of Engineering and Informatics University of Bradford Bradford United Kingdom
– name: 7 Leeds Institute for Data Analytics Leeds United Kingdom
– name: 9 Department of Cardiology Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/34817384$$D View this record in MEDLINE/PubMed
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crossref_primary_10_1097_NHH_0000000000001368
crossref_primary_10_1155_2023_9990933
crossref_primary_10_1097_NCQ_0000000000000747
crossref_primary_10_1097_CIN_0000000000001212
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Copyright Natasha Alvarado, Lynn McVey, Mai Elshehaly, Joanne Greenhalgh, Dawn Dowding, Roy Ruddle, Chris P Gale, Mamas Mamas, Patrick Doherty, Robert West, Richard Feltbower, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.11.2021.
2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Natasha Alvarado, Lynn McVey, Mai Elshehaly, Joanne Greenhalgh, Dawn Dowding, Roy Ruddle, Chris P Gale, Mamas Mamas, Patrick Doherty, Robert West, Richard Feltbower, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.11.2021. 2021
Copyright_xml – notice: Natasha Alvarado, Lynn McVey, Mai Elshehaly, Joanne Greenhalgh, Dawn Dowding, Roy Ruddle, Chris P Gale, Mamas Mamas, Patrick Doherty, Robert West, Richard Feltbower, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.11.2021.
– notice: 2021. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
– notice: Natasha Alvarado, Lynn McVey, Mai Elshehaly, Joanne Greenhalgh, Dawn Dowding, Roy Ruddle, Chris P Gale, Mamas Mamas, Patrick Doherty, Robert West, Richard Feltbower, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.11.2021. 2021
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Issue 11
Keywords QualDash
data
dashboards
support
audit
quality
Language English
License Natasha Alvarado, Lynn McVey, Mai Elshehaly, Joanne Greenhalgh, Dawn Dowding, Roy Ruddle, Chris P Gale, Mamas Mamas, Patrick Doherty, Robert West, Richard Feltbower, Rebecca Randell. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.11.2021.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
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Snippet Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data...
Background: Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support...
BackgroundDashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data...
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SubjectTerms Audits
Cardiology
Child
Clinical governance
Clinical medicine
Cognitive load
Comprehension
Data Collection
Data quality
Delivery of Health Care
England
Evaluation
Feedback
Focus groups
Governance
Health care
Health services
Hospital wards
Humans
Information technology
Intensive care
Internet
Intervention
Mortality
Original Paper
Patients
Pediatrics
Quality control
Quality Improvement
Quality management
Quality of care
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Scrutiny
Teaching hospitals
Usability
Usefulness
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