UNSTRUCTURED
Objective: Dashboards can support data-driven quality improvement in healthcare. They visualise data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices to impact patient care needs further investigation. This paper reports the findings of a realist evaluation of a web-based, interactive quality dashboard (QualDash) developed to support use of national audit data in quality improvement.
Methods: QualDash was co-designed with data users and installed in eight clinical services across five healthcare organisations in England between July and December 2019. Local ‘champions’ were identified to support uptake and adoption. Data to evaluate QualDash were collected between August 2019 and August 2021 and consisted of (1) 148.5 hours of observations including hospital wards and clinical governance meetings, (2) logfiles that captured the extent of use of QualDash and (3) a questionnaire, based on the Technological Acceptance Model, to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analysed to understand how, why and in what circumstances QualDash best supported use of national audit data in quality improvement.
Results: The services into which QualDash was introduced varied in the amount and type of resources available to support data use. These variations, alongside early staff interactions with QualDash, shaped its use and impact during the evaluation period. Well-resourced sites with skilled audit support staff and local data management systems, continued to use established processes to access and use data. Factors constraining use of QualDash in these contexts included the use of local systems to report metrics not configured in QualDash; staff not being fully aware how QualDash could facilitate their work; and champions’ initial reluctance to lead use of QualDash until some metrics were reconfigured to reflect user expectations. In services less well-resourced to use data, QualDash automated parts of their routine reporting process, streamlining the work of audit support staff, and, in some cases, it highlighted issues with data completeness that they worked to address. Furthermore, questionnaire responses indicated that QualDash was perceived as useful and easy to use despite its variable use in practice.
Conclusions: Interactive, web-based dashboards, such as QualDash, have potential to support use of national audit data in quality improvement by facilitating access to and interactions with data. To optimise use and impact, findings suggest that codesign would benefit from greater scrutiny of dashboard visualisations pre-installation, by site staff knowledgeable about metric configurations. Additionally, further consideration should be given to the processes surrounding dashboard use, including data collection, that underpin user confidence in dashboard functions.
INTERNATIONAL REGISTERED REPORT
RR2-10.1136/bmjopen-2019-033208
Measures of promptness of cancer diagnosis in primary care: secondary analysis of national audit data on patients with 18 common and rarer cancers
