4.4 Article

Closing the loop: a 10-year experience with routine outcome measurements to improve treatment in hand surgery

Journal

EFORT OPEN REVIEWS
Volume 6, Issue 6, Pages 439-450

Publisher

BRITISH EDITORIAL SOC BONE & JOINT SURGERY
DOI: 10.1302/2058-5241.6.210012

Keywords

dashboard; patient-reported experience measurements; patient-reported outcome measurements; score-card; surgeon feedback loop; value-based healthcare

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Routine outcome measurements are crucial in value-based healthcare and can lead to improved quality of care, but implementing feedback loops for continuous improvement is often challenging. The journey from measuring outcomes to changing daily care should involve routine analysis and feedback loops to accelerate the learning cycle and enhance treatment outcomes.
Routine outcome measurements as a critical prerequisite of value-based healthcare have received considerable attention recently. There has been less attention for the last step in value-based healthcare where measurement of outcomes also leads to improvement in the quality of care. This is probably not without reason, since the last part of the learning cycle: `Closing the loop', seems the hardest to implement. The journey from measuring outcomes to changing daily care can be troublesome. As early adopters of value-based healthcare, we would like to share our 10 years of experience in this journey. Examples of feedback loops are shown based on outcome measurements implemented to improve our daily care process as a focused hand surgery and hand therapy clinic. Feedback loops can be used to improve shared decision making, to monitor or predict treatment progression over time, for extreme value detection, improve journal clubs, and surgeon evaluation. Our goal as surgeons to improve treatment should not stop at the act of implementing routine outcome measurements. We should implement routine analysis and routine feedback loops, because real-time performance feedback can accelerate our learning cycle.

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