**Basic steps for the design of quality indicators**

An indicator is:a measure used over time to identify, beyond point values, trends in the behavior of a variable, in order to intervene.

#### By Juliana Soto Gómez

Quality Management Leader – IPS mic Clinical Research Center

One of the greatest challenges for health care organizations and clinical research centers during the shaping of their quality processes is the need to formulate quality indicators that serve as a tool for decision making.

**The objective of this article is to offer some simple strategies that can facilitate the process of designing and implementing quality indicators.**

The idea is to allow the measurement of the necessary processes and to obtain the desired results for decision making.

Often, the indicators that are designed do not have the necessary robustness to fulfill their function, which clearly diminishes the effectiveness of quality management.

**Rules of thumb**

**What it is:** An indicator is a measure used over time to identify, beyond point values, trends in the behavior of a variable, in order to intervene.

**The variable: **The first challenge when defining an indicator is to clearly identify the variable or characteristic to be measured.

**Time**: Defining the time for which the indicator will be measured is important and depends on the variable to be measured or the type of indicator to be defined.

**Measurement**: Preferably measure the results as impact facilitators.

**Mathematical Types:** Select appropriately the mathematical types for the indicators to be used to measure the performance of the processes.

**Stability:** Make sure that to measure an indicator the data feeding it must be available and reliable.

**Focus:** Design a prudent number of indicators to actually measure critical process data.

**Characteristics of a good indicator**

Quality indicators are measuring instruments that allow to measure the real performance of the company’s processes or procedures, and its changes over time, for this it is of vital importance to build them under the following characteristics:

**It is reliable,**Its results are not affected by a change of evaluator, which allows confidence in spatial and temporal comparisons.

**It is valid,**the indicator effectively measures what it is intended to measure and not another variable.

**It is sensitive,**it is capable of perceiving changes in quality, it does not generate false negatives.

**Specific,**not affected by other phenomena, does not generate false positives.

**Relevant,**focusing on the measurement of fundamental aspects of quality.

**Tipos de indicadores**

To begin the process of developing quality indicators, we must be clear about the types of indicators and the focus of each one of them:

**Structure indicators**generally measure accessibility, sufficiency or availability and suitability or adequacy for use.

**Process indicators**measure timeliness, punctuality, relevance, continuity, coverage and efficiency.

**Outcome indicators**measure efficacy, satisfaction and safety.

**Impact indicator,**measures effectiveness and equity.

Once the type of indicator to be implemented is clear, the next step is to choose the mathematical type to be used.

**Mathematical types for the development of indicators**

When selecting the mathematical type for an indicator, generally the proportion and the average are always chosen; however, the characteristics of each type must be evaluated to establish which of them is the most appropriate for our indicator, and it must also be taken into account that not all mathematical types apply to all types of indicators:

**A proportion** is an indicator in which a relationship is established between a part and the whole, i.e. the amount destined in the numerator will be included again in the denominator and the result obtained from this formula is multiplied by a constant which is regularly 100.

**An average **is an indicator in which a relationship is established between the sum of quantities and the total number of measurements made.

**The index** is an indicator in which a relationship is established between a part and the whole, i.e. the amount allocated in the numerator will be included again in the denominator, unlike the ratio, the amounts allocated for the numerator and denominator are of a different nature.

**The rate** is a special form of index, the basic characteristic of rates is that it incorporates the time variable in the denominator. Clinical rates are used in quality exclusively in the field of safety, their multiplying factor is usually 1000.

**The Ratio **is an indicator that compares two quantities of different nature, depending on the type of ratio, these may or may not have multiplying factors.

Keeping in mind these basic steps for the definition of quality indicators, you will be able to start measuring all the activities that the organization considers pertinent and thus complete the processes of continuous improvement.

#### By Juliana Soto Gómez

Quality Management Leader – IPS mic Clinical Research Center