Traditionally, healthcare has been more influenced by lagging indicators. The reason why —
the data and technology were designed to support lagging indicators. Now with advanced
AI-enabled
In computer science, the term
artificial intelligence (AI)
refers to any human-like intelligence exhibited by a computer, robot, or other machine.
In popular usage, artificial intelligence refers to the ability of a computer or machine to mimic the capabilities of the human mind.
analytics, organizations are armed with large structured and unstructured data sets to support the shift from lagging to leading indicators .
What is a lagging indicator?
Lagging indicators measure a hospital's incidents in the form of past accident statistics. Examples include:
- Number of fatalities
- Injury frequency and severity
- Lost workdays
- OSHA Occupational Safety and Health Administration (OSHA) was created within the Department of Labor and is responsible for worker safety and health protection. recordable injuries
- Near-mis incidents
- Worker’s Compensation trends and costs
- Asset/property damage
Why use lagging indicators?
Lagging indicators are the traditional safety metrics used to indicate progress toward compliance with safety rules. These are the bottom-line numbers that evaluate the overall effectiveness of a hospital.
The drawbacks of lagging indicators.
The major drawback to only using lagging indicators of safety performance is that they tell you how many people got hurt and how badly, but not how well your hospital is doing at preventing incidents and accidents.
The reactionary nature of lagging indicators makes them a poor gauge of prevention. For example, when managers see a low injury rate, they may become complacent and put safety on the bottom of their to-do list, when in fact, there are numerous risk factors present in the workplace that will contribute to future injuries.
Example
You meet a patient for the first time. He says he wants to lose weight, a clear lagging indicator that is easy to measure. You give him a diet regimen and ask him to check in every month. When the patient comes in for the monthly check, he weighs himself to record his progress to date. Without additional checkpoints during the month, there is no understanding of how he is tracking to his goal.
What is a leading indicator?
A leading indicator is a measure preceding or indicating a future event and is used to drive and measure activities carried out to prevent and control injury. Examples include:
- Safety training
- Supervisor training
- Employee training
- Safety/health meetings
- Risk/hazard assessment
- Number of inspections
- Number of audits/surveys
- Observations/accidents
- Employee perception surveys
- Employee turnover rate
- Reward/recognition
- Ergonomic opportunities identified and corrected
Why use leading indicators?
Leading indicators are focused on future safety performance and continuous improvement. These measures are proactive in nature and report what employees are doing on a regular basis to prevent injuries.
Hospitals dedicated to safety excellence are shifting their focus to using leading indicators to drive continuous improvement.
- there is a link between hand washing (leading) and infections (lagging)
- monitor children with lesions, spider bites, cellulitis in children since these often predict MRSA
- leading health indicators are: physical activity, weight, tobacco use, substance abuse, mental health, immunizations, etc.
Advantages of using leading indicators
- Allow you to see small improvements in performance
- Measure the positive: what people are doing versus failing to do
- Enable frequent feedback to all stakeholders
- Be credible to performers
- Be predictive
- Increase constructive problem solving around safety
- Make it clear what needs to be done to get better
- Track Impact versus Intention
Example
The same patient who came to you about wanting to lose weight. You give instructions on what the patient can do to lose weight. However, this time, part of the instructions include:
- a daily goal of tracking what they need to eat and drink
- a nutrition target
- a weekly exercise goal
When the patient comes in every month to check in, he already has a good idea whether he has progressed toward or met his goal.
But how do you actually reach your goal? For weight loss there are two leading
indicators: (1) Calories taken in and (2) Calories burned. These two indicators are easy to influence but very hard to measure. In this scenario,
• the daily tracking goal is the leading indicator
• the monthly check-in is the lagging measure
Daily tracking gives the patient quicker insight as to whether he is on track to meet his goal. If a patient only checks in monthly, he is not able to correct his course which leads to the goal either not met on the timeline or not met at all!
COVID-19 Lagging Indicators [3]
When you are referring to a diagnostic test, identifying viral load, like the nucleic amplification tests, you are looking at a leading indicator: how many new cases you are identifying. And that would be a useful metric except for one problem; the number of positive tests has a lot to do with the population being tested. If there were no new infections tomorrow, the number of positive tests would be higher in nursing homes than nursery schools. So not so helpful.
In the same way, it doesn’t help us understand how extensive the testing is currently. At best, if you want to get a meaningful metric on testing, we would need to see the number of tests per some population metric, say 10,000 or 100,000 people – even better, the same metric in your locality.
Since the media are not always careful to separate testing for the presence of infection from testing for the prior existence of the disease, we should also consider positive antibody testing. Once again, the same dilemma, the number of previously exposed individuals will vary by their susceptibility, exposure, and locale. While a positive antibody test is a lagging indicator, it doesn’t help us see where we stand. It can provide some sense of how widely the disease has spread, but again it depends on the population you target.
COVID-19 Leading Indicators [3]
There are several metrics we might consider, initial hospitalizations, ICU admissions, patients on ventilators, and deaths. Initial hospitalization is a lagging indicator if you are looking at new infections, but it is a leading indicator if you are concerned with hospital capacity and deaths.
Despite our best efforts and now remdesivir, medicine has not altered outcomes as much as we would like, although remdesivir does offer some reduction in length of stay. So the patients requiring intensive care, ventilatory assistance, and succumbing to COVID-19 are indirect measures of those hospitalized. Without a significant therapeutic breakthrough, the relation of admission to those three other variables is going to remain relatively constant.
Deaths are perhaps the most troubling measure of all. It is a lagging indicator, but many, if not all, the deaths at home are being attributed to COVID-19.
If you want to follow COVID-19 as we begin to mingle once again socially, I would suggest tracking hospitalization because it is the one metric that can be rate-limiting, it measures not only those requiring care but is a gauge of hospital capacity.
Futuristic Scenario [1]
Apply definitions of leading and lagging measures to patient satisfaction surveys
When it comes to patient experience, many organizations are using patient satisfaction surveys (such as CAHPS) as the measure of overall rating or likelihood to recommend. Patient surveys are a lagging measure because the results are retrospective (it takes weeks to months after the patient encounter to receive feedback). The data is made available too late to make timely changes to the process.
Real-time feedback leads to team and patient engagement
Team engagement changes when employees can see real-time feedback, or leading data. The missing link is leading data that is provided as an event takes place so that outcomes can be influenced.
Texting patients during their ER visit
For example, if we have the ability to send a text to a patient at specific times during their Emergency Department visit and get that feedback in real time, we can intervene with appropriate service improvements and timely response to their feedback.
As we take that data, look at the insights and analytics, and share it with the team, we have the ability to influence our monthly, quarterly and ultimately yearly outcomes. By acting on leading data, organizations can see the downstream impact on their lagging indicators.
References
- Land T. How Leading Indicators in Healthcare Are Driving Change in the Industry www.medallia.com/blog/ 2021-03-29.
- Middlesworth M. A Short Guide to Leading and Lagging Indicators of Safety Performance ergo-plus.com 2020-04-24.
- Dinerstein C. COVID's Leading And Lagging Indicators www.acsh.org 2020-05-15.
- Risktec. Measuring safety – safety related key performance indicators risktec.tuv.com/risktec-knowledge-bank/ 2021.