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measures to judge their success. You might argue that you know if things are getting better; you can just tell. I am sure that you can. This is not enough, though. In the healthcare field it is important to measure improvement. One reason to do so is to prove to others that things are improving. For instance, suppose you are in charge of implementing electronic health records in a hospital setting. You meet resistance from several staff members, including a large number of doctors. How can you overcome this resistance? Collect dataùlower percentage of wrong prescriptions, for instanceùfrom a pilot program of willing participants and then demonstrate the positive benefits with your data. With such results in hand, you will overcome many doubters. Another reason to measure improvement is to demonstrate the saving of time and money. With healthcare costing so much today that many find care out of their price range, it is important to find ways to lower costs. For instance, suppose that staffing at your facility is very expensive; the payroll costs are way over budget. I recently read of a lean six sigma project that demonstrated through the use of data collecting by staff charge nurses that staffing shortages and costs were significantly reduced. The right staff was present when needed and the facility eliminated the need for using short-term staffing of nurses through agencies; this saved a great deal of money. Besides lowering costs, staff morale improved significantly at this site. I hope that I have convinced you that to make significant quality improvements, you should be actively measuring. What should you be measuring? The most common measurements are costs in providing a service, time taken in providing a service and various measures of patient health, such as the lung capacity of asthmatics. You can also measure improved bottom lines. One doctor I know improved his income 38% in 5 years by working hard to adopt quality measures in his solo practice. Many ERÆs now boast of how they have significantly decreased waiting time for patients. One such local hospital did so well that they were overwhelmed by the increase of demand for service at their ER. You might want to measure if spending a few more minutes with patients talking about pursuing good life habits like eating the right foods leads to improved health, like lower cholesterol. Once you have decided what to measure, you should first measure the variable (cost, time, etc.) as it is in the state before

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