The use of dashboards to monitor quality of care.

The use of performance dashboards dates back to the 1970s but did not gain popularity until the 1990s when the digital revolution transformed the manner in which information is managed within organizations. The healthcare industry has been particularly slow to adopt the usefulness of the dashboard, especially for clinical applications. As the storage of health information in electronic format continues to grow,many healthcare institutions are beginning to appreciate the benefit of using the dashboard as a decision support tool. For the clinical nurse specialist (CNS), a dashboard can be an important tool in monitoring the quality of patient care. A performance dashboard is a ‘‘graphical comparison of actual performance to a desired performance giving an at-a-glance view of the health of an organization.’’ Dashboard tools are best known as simple displays of key performance indicators that are engineered to keep the complexities of the underlying software system out of sight. The software application can tap into the organization’s electronic health record or enterprise data warehouse to generate automated reports with drill-down capabilities. The user interface is most commonly displayed using intuitive analogies, often much like a car dashboard with traffic-light color coding. Effective dashboards have data presented within a single page, use a compelling visual display of key performance indicators, can be easily understood by all levels of staff, and can be easily updated. The CNS can have a pivotal role in the design of a performance dashboard for quality improvement. To establish an effective and successful application, it is important for the dashboard to contain information that is current, accurate, and reliable. TheCNS can identifymeaningful metrics to measure the quality of patient care and ensure those data are carefully defined and collected within the electronic health record. Benefits of the dashboard are that it provides a snapshot of overall performance; it provides an early indication of negative performance trends so that corrections canbemadequickly; it shows the impact of newprograms, policies, or strategies; and it shows the performance of key variables before interval reports. As such, the dashboard is aneffective tool to incorporate into iterativePDSA (plan-dostudy-act) cycles as part of a quality improvement program. Dashboards are adaptable business intelligence tools for healthcare agencies that support nimble decision making in alignment with strategic plans. The ability to combine business, operational, and clinicalmeasures allowsusers to track organization-wide as well as unit-based performance in real time. Analysis of current data can promote timely identification of negative performance trends, flag priorities, and accelerate the PDSAcycle. The intuitive display ofmeaningful data usually appeals to a variety of end-users. The increase in organization-wide awareness of responsibility for key performance indicators often promotes ownership, and rewards improved performance. Spillover effects on the organization-wide culture of accountability and culture of safety have been described as additional benefits. Dashboards have been used to improve decisional potential for all levelswithin healthcare organizations.Whereas dashboards aremost common in executive suites andboardrooms, dashboard templates to enhance and accelerate performance improvement projects are increasingly available. Successful utilization of dashboards has transformed the workflow in a variety of patient care departments, such as maternity units, emergency rooms, and operating suites. Recently, dashboard use has been extended to support the decisions of individual clinical practitioners, such as directcare nurses. The dashboard, by definition, should be accessible to all levels of staff, regardless of trainingor education. Thismakes Author Affiliations: Department of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois (Mr Carroll); University of Colorado College of Nursing, Hesperus (Ms Flucke); Clinical and Community Affairs, University of Colorado College of Nursing, Centennial (Dr Barton). The authors report no conflicts of interest. Correspondence: Amy J. Barton, PhD, RN, FAAN, College of Nursing, University of Colorado Denver, 7983 S Trenton St, Centennial, CO 80112 (amy.barton@ucdenver.edu). DOI: 10.1097/NUR.0b013e31828191b5