Measurement of Trauma-Informed Care
Measurement is a key driver of turning best practices into common practices. We apply this insight to the work of health systems to embed best practices on trauma-informed care in their service delivery, organizational policies, and infrastructure design.
Health care systems sometimes struggle to maintain engagement in this work because measurement strategies focus on improvements to patient outcomes and quality of care, which can require long lead times to measure. Focusing only on these lagging measures means that health systems miss key leading measures of their shift towards being trauma-informed. A full measurement plan of trauma-informed care in health care delivery systems should incorporate leading organizational-level, patient-level and provider-level metrics.
The Institute for Healthcare Improvement’s Framework for Spread is often cited in literature detailing the organizational uptake of trauma-informed care practices. This framework outlines three general steps:
(1) Prepare for Spread,
(2) Establish Aim for Spread, and
(3) Develop, Execute, and Refine Spread Plan.
The first step, prepare for spread, calls back to the implementation domain discussed in our blog post last week: Governance and Leadership. Executive leaders should determine what knowledge and attitudes towards trauma-informed practices exist, what resources will be available to guide potential changes, and overall organizational readiness.
Several organizational assessments are available specific to trauma-informed care implementation in the workplace including the Trauma-Informed Organizational Self-Assessment or the variety of tools outlined here. The purpose of these organizational assessments is to identify an organization’s strengths and weaknesses and recommend where to begin efforts toward system-wide change.
Using an organizational assessment allows an organization to more accurately move towards the second step of the IHI framework: Establishing Aim for Spread. Here is where the organization will select the population, goals, improvements to be made and time frame for the effort. Within this step, it will be important to identify appropriate metrics specific to the interventions that are planned. For example, if an organization identifies staff training as a key starting point, goals pertaining to what portion of the staff will be trained by what time will need to be tracked.
The third and final step in the framework is Develop, Execute and Refine Spread. Measurement should incorporate both process measures to gauge adherence to new behaviors or processes, as well as initial outcomes measures to gauge incremental improvements and identify opportunities for further refinement of work, or prioritization of new interventions. Think of this step as an ongoing PDSA cycle that feeds and reinforces change.
Health care delivery systems should also select what patient health outcomes will be important to track. The patient satisfaction survey is a mainstay of the health care delivery system in the United States. This survey may be a good asset to call upon if your organization feels confident that there are questions pertaining to principles of trauma-informed care. Questions asking about patients’ comfort within the physical environment, patient evaluation of their provider(s), and the degree to which the patient/family is involved in discussing the care plan are all directly correlated to trauma-informed care practices.
Another helpful leading metric is tracking the results of relevant screening protocols, both in terms of discrete patient answers and system actions that result. Screenings for adverse childhood experiences or social determinants of health are becoming more common as health care delivery systems move to become fully trauma-informed.
A separate measurement plan focused on screening-based interventions will allow a health care delivery system to assess how well they are meeting their screening goals (e.g., screen every patient who walks in the door), what the needs of their children and families are (e.g., the families that our clinic serves often need transportation and childcare), and the results of any resource connections (e.g. our clinic tracks what resource was provided and follows-up at an appropriate time period). Monitoring the screening process will allow a health care delivery system to see where progress can be made, and also may highlight new service mechanisms or community-based partnerships that could be aligned to better serve patients and families.
Measuring process and outcomes metrics related to training and workforce development are another key component of reinforcing trauma-informed care. Provider burnout is of increasing concern to health care delivery systems. Trauma-informed care practices can help reduce the experience of secondary or vicarious trauma of staff in health care delivery systems. Retaining providers is critical to the success of healthcare delivery systems; therefore, tracking the satisfaction of providers, the degree of burnout experienced by providers, self-care practices they engage in, level of organizational support felt by the providers, and self-competence to engage in trauma-informed care practices throughout the process of becoming a trauma-informed care organization are important components of this measurement domain.
Genesis Health Consulting has significant experience coaching organizations on how to successfully facilitate change within their business, and to work across sectors to manage change within their industry or community. We welcome the opportunity to learn about your particular challenge, and to share more about our experiences. Please contact us at: firstname.lastname@example.org.