Table 3

Overview of methodological, contextual and managerial fitness for use considerations

ClustersConsiderationsGuiding questions for considering an indicator’s use
Measures what matters.Does anybody care?
Wide engagement.What can we do?
Easily interpreted.Does the indicator signal a clear direction?
Clear standardisation.Is the indicator clearly defined and replicable?
Alignment of accountability.Are entry points for taking action feasible?
Measurement matches delivery.Is the indicator a reflection of the system?
Sensitive to meaningful change.Is the indicator sufficiently sensitive to change?
Information infrastructureInteroperability.Can needed data be accessed?
Data quality.Is the data of quality?
GovernancePolitical will and vision.Is there high-level commitment and direction for use?
Regulation for data protection.Does existing legislation facilitate use?
Cross-sector partnerships.Are cross-sector partnerships in place?
Aligned financing structures.Do financing structures encourage the intended use?
Workforce capacityData and quality expertise.Are the competencies to interpret and use data in place?
Time dedicated to improvement.Is time allocated to encourage use?
CultureLearning orientation.Is an environment for learning cultivated?
Shared responsibility for health.Do users feel accountable for improvement?
Selecting healthcare performance indicatorsClear purpose of use.What is the purpose of use? (eg, strategy development)
Target end user is known.Is the target audience known? (eg, clinicians, public)
Conceptual framework.Is the dimension of quality pursued clear?
Indicator quality.Is the indicator scientifically sound?
Source, type and availability of data.What data are needed and are they available? (eg, administrative, clinical, survey data, wearables)
Standards for appraisal.How will improvements in performance be assessed?
Degree of public disclosure.Is the indicator for internal or external (public) use?
Accompanying indicators.Are there relevant accompanied indicators?
Previous use.Has the indicator been used previously?
Accessing dataRepresentativeness of data.Are the data complete?
Data linkages.Can relevant data sources be linked?
Data collection tools.How will data be collected? (eg, paper-based, automated electronically, manual electronic entry)
Unity of language/coding.Is there consistency in coding across data to be used?
Applying methods of analysisType of analysis.How will the data be analysed? (eg, benchmarking, time trend, case mix correction)
Aggregation of indicators.How can composites/indices be used to simplify data?
Reference group.Who is the reference group?
Breakdowns/cohorts.How will the data be disaggregated? (eg, age, sex, ethnicity, geographically)
Calculation of values.How will values be calculated? (eg, mean, median, SD, top 10% mean)
Time interval.Should a time trend be reported and at what interval?
Application of risk adjustments.How will risk adjustments be applied? (eg, variable specification, source, weighting scheme)
Managing missing data.How will missed data points be handled?
Contextualising data.What other data are needed to give the indicator meaning?
Displaying findingsChart options.How will the data be visualised? (eg, chart, map, table)
Simplification techniques.What techniques to simplify the meaning can be applied? (eg, colour, size variation, icons)
Customisation of display.How can users customise the data? (eg, change of display, change of information)
Narrated interpretation.How can the quality and the meaning of data be narrated?
Format of reporting.How will it be reported? (eg, print, mobile, web-based)
Reaching decision-makersFrequency of reporting.What is the relevant reporting cycle (eg, real time, quarterly, annually, biennially)
Dissemination channels.How will users be reached? (eg, mail, email, champions)
Guidance on use.How can users be supported to make use of findings?