Designing for audit & feedback

Audit & feedback is a method of continuing professional development in which the healthcare provider (or group of healthcare providers) is shown data summarizing one aspect of their practice to help them understand how their practice can be improved. In my experience, the focus has mainly been on test or scan utilization (i.e. methods of testing for bronchiolitis), but other measures are often included - such as patient demographics or length of stay.

The delivery of the feedback is evolving and the subject of more than a few studies, which are being conducted by a few research groups internationally. Within one of those groups, my role has been to provide an information designer's perspective on the visualization of data and design of the document delivering the feedback.

Over time, I lead the development of a process for the generation of these documents - called 'individualized practice reports' - and three guidelines for designing the reports:

1. Be a minimalist

Studies show that physicians already have a hard time translating data and feedback into their practice. To reduce the mental effort it takes to understand what the reader is seeing, use color and visuals to draw the reader's eyes towards important content on the page.

2. Group content into "chunks"

We naturally assume content that's close together is related. Consider breaking content up so that anything close together is working towards the same point.

3. Keep a consistent information map

Based on a method for writing technical documents, be consistent with your layout and information representation. For example, page titles should be in the same place and same font across the document and processes should be shown as visuals or numbered steps. The goal is to minimize the amount of time the reader is spending trying to understand what they are looking at.

4. Visualize the data for easy comparison

A core concept of audit & feedback is to give the provider a way to form an understanding about their own practice. Current literature supports the use of comparators - such as other providers, sites or groups of providers - to help the provider form a context-sensitive understanding of their practice.

Report generation process

When I started with the program, the entire process (data analysis/visualization and report generation) was done in Microsoft Excel. With this approach, there were challenges with formatting and consistency across the document. If a column width changed with the values, then the entire report layout shifted.

The next iteration of this process introduced Microsoft Word to solve the formatting issues. Utilizing tables, the issues with formatting were quickly overcome. The ability to link charts and text between Microsoft Office products - such that when the chart changed in Excel it also changed in Word - meant that there was no need to re-enter the data values when generating reports for each physician. However, this new system created new time-related challenges. To generate one report, it was now taking upwards of 8 minutes - far longer than with the previous system.

The current iteration of the process has found me using Visual Basic Advance to write custom macros to automate the process of report generation. A fair amount of manual work is still needed to set up the Word and Excel files, but time to generate the reports has dropped to around 20 seconds per report.

While this may not sound like much of a process improvement, it has greatly compressed the amount of time needed to generating the report and allowed us to spend more time cleaning data and iterating on the visualizations, thus improving the quality of our output.

Looking forward

Recognizing that these reports are hardly standalone documents - often being delivered in a facilitated group discussion - I believe there is room to redefine the individualized practice report and how it is delivered. This is part of the inspiration for my masters research project - Supporting practice improvement.

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Hi there.

I'm an information designer living in Toronto, Ontario.

I'm currently finishing up my master's degree in Design for Health at OCAD University.

My approach to anything design-related in healthcare is underscored by three main ideas:

  1. Healthcare is a complex system.
  2. Complexity isn't something to shy away from.
  3. Personal experiences humanize complexity.

I love data that doesn't fit within traditional, quantitative data visualizations. While those sort of visualizations certainly have their time and place, there's so much more to the data that's being left out.

If you are interested in working together, please email me at chris@designingrice.com.

Or send me a message on linkedin or twitter

For more details about my education and work, here is my CV.

Thanks.

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