Model for Improvement - Establish Measures

Measurement is vital to the improvement process. It tells the team whether the changes are happening as planned, and whether they are resulting in an improvement. The Model for Improvement methodology recommends using a balanced set of three types of measures or Family of Measures including:

  1. Outcome measures (voice of the customer): How is the system performing? What is the result?
  2. Process measures (voice of the working of the system): Are the parts of the system performing as planned?
  3. Balancing measures (looking at a system from different directions/dimensions): Are changes designed to improve one part of the system causing new problems in other parts of the system?

In this project, measures were established for the three pilot communities, as well as Collaborative rubrics, based on the Healthy People Action Model.

Measures established in three pilot communities

MeasureType/Team Clinton County Team Franklin County Team Schenectady County Team
Outcome Measures (data source)
  • Sales of fresh fruit in the high school (cafeteria inventory and production records, Nutrikids food service management software)
  • Sales of modified items identified in the menu (cafeteria inventory and production records, Nutrikids food service management software)
  • Overall sales of school lunches (cafeteria inventory records, Nutrikids food service management software)
  • Sales of reduced cost/free lunches (cafeteria inventory records, Nutrikids food service management software)
  • Sales of adult lunches (cafeteria inventory records, Nutrikids food service management software)
  • Increased fruit consumption (cafeteria inventory records, Nutrikids food service management software)
  • Increase sales of new healthier menu items: meatballs, baked breaded pork, fish sticks.(cafeteria inventory records, Nutrikids food service management software)
  • Fourth grade student active time per day and per week (Recorded by staff)
Process Measures
  • Product placement (observation)
  • Product marketing (observation)
  • Product pricing (observation)
  • Menu enhancements (menu)
  • Placement of skim milk to make it easier to access than chocolate milk (observation)
  • Better signage (observation)
  • Offering cut fruit (menu, observation)
  • Conducting taste testings (records and surveys) with students
  • Setting up indoor walking track (observational)
  • Scheduling a three week intervention for 10 minutes per day for two days per week (schedule)
Balancing Measures
  • Student feedback from taste testings (postcard survey)
  • Student feedback from taste testings (survey)
  • Teacher and administrator feedback (informal feedback, observation)
  • Student feedback (informal feedback)

The Institute of Healthcare Improvement website explains the difference between measures used for research and for measures used in learning and improvement in practice. The website also has tips for effective measures.