Three-Part Data Review
The Three-Part Data Review Method
My colleagues at IHI developed a data review method that combines qualitative and quantitative data. This method helps users design and operate better healthcare systems by understanding specific populations' assets and needs.
The IHI guide has practical suggestions for wording and tips for summaries of the conversations.
Here are the three parts of the review defined by the IHI authors:
“1. Reviewing available [numerical] data on the population to identify overall patterns that impact the chosen population
2. Engagement with care teams and professionals providing care or supporting the population to understand their perspective on the chosen population’s greatest needs and assets
3. Patient/client/individual interviews and engagement to understand their experience and perspective; to understand what is important to them, the real-world challenges they face in managing their health and living situations, and what might help”
(https://www.ihi.org/resources/publications/population-health-guide-undertaking-three-part-data-review, accessed 11 November 2024)
An Everyday Version—the spirit of three-part data review
In 2024, with access to powerful data visualization tools and big stores of numerical information, it’s easy to overlook the value of conversations.
I encourage the care teams I work with to adopt the spirit of the three-part data review. This means teams use three sources of information to operate and improve their care systems:
Numbers such as counts or percentages of patients with specific diagnoses and attributes, waiting time for service, and rates of problems.
Conversations with care teams and professionals to understand views and experiences.
Conversations with patients and their families to understand their experience.
Conversations frequently yield insights that are not captured by analysis of the numbers.
More importantly, conversations help you avoid confusing the reality of the care system with a mental model derived from just the numbers. See this reminder about the limitations of our mental models.
The Simplest Conversation?
I’ve encouraged the teams I coach to try the Plus-Delta approach, which involves short conversations with providers and service users.
Teams ask Plus-Delta questions on a test basis using one or more Plan-Do-Study-Act cycles.
Why ask clients or patients a couple of open-ended questions, listen to their answers, and reflect on what you heard?
“Plus” answers offer benefits and gratitude for your care that speak to your heart and to your brain.
“Delta” answers surface things you can do now to improve patient experience. Small wins build energy while reducing daily friction.
The Experience at Eagle View Community Health System
What about asking the two questions of care team members and professional colleagues?
Eagle View Community Health System is a Federally Qualified Health Center with three clinics in Illinois. Yvonne Fillmore, NP, learned Plus Delta questioning in 2022. Yvonne and her colleagues participated in a project led by the National Network for Oral Health Access. The project aimed to help FQHCs improve oral health care for patients with diabetes.
Yvonne adjusted the daily huddles of the medical team at her clinic to ask Plus-Delta every day. Here’s a picture that shows how Yvonne’s team uses a problem-management process connected to the daily huddles.
Eagle View teams were already doing daily huddles before Yvonne’s change. Plus-Delta is just a small revision to the huddle agenda, not much of a burden. Now many issues are addressed relatively quickly using the problem-handling process. Work experience is better. The change to use Plus-Delta has stuck and is spreading within the health center.
How to ask about the care experience
Last spring I worked on a project where teams worked to avert hospitalizations for older patients presenting at Geriatric Emergency Departments. I introduced Plus-Delta to the project teams and then shared this table to encourage their testing. The table uses the Job Instruction Breakdown format that summarizes how I teach the skill.
Acknowledgment
Thanks to Yvonne Fillmore, NP, Eagle View Community Health System, for permission to share her experience.