Leading indicators in healthcare tell you if you are likely to achieve a goal. And, employee and patient engagement leads the charge.
First you lead, then you lag. It sounds like the lyrics for a line dance. But measurement is one of the major barriers to achieving our goals and one of the missing pieces of data in healthcare. Every year we set our corporate goals with every intention of achieving them. We cascade the message and show monthly or quarterly progress. We have all heard the phrase that “we are data rich, insights poor and time starved.” However, we have consistently lacked data that tells a story that drives action and improves outcomes — until now. By turning our focus to leading indicators in healthcare, organizations can determine which measurement drives the most desired results.
Now let’s start by defining these indicators:
Lagging measures: Lagging indicators are retrospective and outcomes based. They are typically output oriented. They are easy to measure, but difficult to improve or influence.
Leading measures: Leading indicators are usually proactive and predictive. They are typically input oriented. They are more difficult to measure but easier to influence.
A lagging measure tells you if you’ve achieved the goal; a leading measure tells you if you are likely to achieve the goal. Leading measures are your predictors and help you to course correct.
Traditionally, healthcare has been more influenced by lagging indicators. There is a good reason why — the data and technology were designed to support lagging indicators. Now with advanced AI-enabled analytics, organizations are armed with expansive structured and unstructured data sets to support the shift from lagging to leading indicators.
Let’s look at a couple of examples of how lagging and leading measures play out in a typical patient scenario.
Scenario 1: You have two patients that need to lose 25 pounds in six months.
Patient 1: You meet the patient for the first time, give them a diet regimen and ask them to check in every month to see how they are progressing toward the goal. When the patient comes in for the monthly check, they weigh themselves to record their progress to date. Without additional checkpoints during the month, there is no understanding how they are tracking to their goal.
Patient 2: After you meet the patient the first time, you give instructions on what the patient can do to lose weight. However, for this patient, part of the instructions include a daily goal of tracking what they need to eat and drink, a nutrition target and a weekly exercise goal. When the patient comes in every month to check in, they already have a good idea whether they have progressed toward or met their goal.
In this scenario, the daily tracking goal is the leading indicator while the monthly check-in is the lagging measure. Daily tracking gives the patient quicker insight as to whether they are on track to meet their goal. If a patient only checks in monthly, they are not able to course correct which leads to the goal either not met on the timeline or not met at all.
Scenario 2: Two leaders have a goal to increase the retention rate of first-year RNs by 20%.
Nurse Leader 1: The HR team in partnership with nursing leadership works to create nurse journey maps where they identify the important milestones in a first-year RN’s journey: onboarding, training and development, preceptor relationship, relationship with leader and team collaboration. Nurse Leader 1 reviews this data every month and updates progress-to-goal in one-on-one sessions with her leader.
Nurse Leader 2: The HR team in partnership with nursing leadership works to create nurse journey maps where they identify the important milestones in a first-year RN’s journey: onboarding, training and development, preceptor relationship, relationship with their leader and team collaboration. Nurse Leader 2 puts a process in place to obtain weekly feedback from her first-year RNs and makes that data visible to all team members. This increases awareness of their progress and starts a regular, weekly conversation with the team on what is going well for the first-year RNs and what can be improved. This data-driven approach helps to enhance the experiences for the first-year RNs, thereby improving the retention rate.
In this scenario, the weekly feedback is the leading indicator and the monthly updates are the lagging indicators. Weekly feedback gives the first-year RNs insight into how they can improve now, not one month from now.
And finally, let’s apply this thinking to a familiar and important financial measurement in healthcare, CAHPS. When it comes to patient experience, many organizations are using CAHPS surveys as the measure of overall rating or likelihood to recommend.
If we apply our definitions of leading and lagging measures to CAHPS, we can all agree that CAHPS is a lagging measure. CAHPS results are retrospective as it takes 45-60 days after the patient encounter to receive feedback. Similar to Patient 1 and Nurse Leader 1 in the above scenarios, the data is made available too late to make changes and course correct.
The missing link for most hospitals is leading data that is provided in the moment to help course correct, provide service recovery, lead to quality employee and patient engagement, and expand positive behaviors so that outcomes can be influenced.
Team engagement changes when employees can see real-time feedback, or leading data. They can see how they are making a difference and how their input helps the team achieve its goals.
For example, if we have the ability to engage in the moment by sending a text to a patient at specific times during their Emergency Department visit and get that feedback in real time, we can intervene with service recovery or elevate kudos to the team on a job well done. Then, 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 such as CAHPS.