Why measure?

So why am I now standing in front of a statue of Lord Kelvin in Glasgow’s Kelvingrove Park, in the shadow of Glasgow University, where Lord Kelvin spent his academic career? Lord Kelvin was a famous mathematician and physicist. He was involved in doing work to establish the first, but more importantly, the second law of thermodynamics. He was a pioneer in telegraph cabling. He patented over 50 inventions and published over 600 scientific papers during his life. But he’s perhaps best remembered for having the absolute temperature scale– the Kelvin scale– named in his honour. His body now lies in Westminster Abbey. On one side lies Isaac Newton– on the other side, Charles Darwin– a man of some considerable genius.

But why am I standing here today? It’s more than 100 years since Kelvin died. Kelvin died before Sir Alexander Fleming made his miraculous discovery of penicillin. Well, I’m standing here today because central to all of Kelvin’s achievements– and he knew this– was the importance of measurement. Lord Kelvin said “To measure is to know.” So what Kelvin means here, I think, is that how can we possibly know something, unless we measure it? How can we possibly know about antibiotic prescribing unless we measure it? But on this subject of importance of measurement, Kelvin went further. He said “When you can measure something and express it in numbers, you know something about it.

But when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.” But I think his most important quote in relation to measurement is where Kelvin says “If you cannot measure it, you cannot improve it.” And this principle that you need to understand the baseline– the point from which you’re starting– in order to know if you are improving things is now a fundamental part of improvement or quality improvement science. Let’s then look at the hospital outbreak and the team’s response to that. Let’s look at this first excerpt of the video, where the medical director is talking to the consultant microbiologist, the antimicrobial pharmacist, and the antimicrobial management lead.

Uh– we tried very hard for them to get to attend many of the meetings around the making of the policy. But ultimately, I’m sorry to say, I just got so fed up that I just put the policy out and hoped for the best. I see. So do we know that they use it? Um– that’s– that’s a good question. I can’t tell you all the time. But we have medical students which we have persuaded to do some audits; they’re always looking for a project. In fact, I remember one, now, around 18 months ago, when we did a project with one of our medical students, and she measured in a compliance rate of around 30% for the treatment bit of the guideline.

So what I think they are saying is that they just don’t know how well the hospital’s prescribers are complying with the prescribing policy. And how could they find this out? Through measurement. Let’s look at the second clip. So what about prophylaxis? And that’s an indicator that we’re now being asked to monitor, and clearly I am accountable for that. Are we doing any better there? Um– well, uh– our performance is around 45% to 60%, at best. Um– we– we kind of can’t measure it on a regular basis, because we can never find anybody, I’m afraid. In the second clip, the medical director is saying we have a standard for surgical prophylaxis. He’s accountable for it.

And yet he doesn’t know how well the hospital is doing. And that’s because there is not a management or a measurement strategy in place. And let’s look at this last clip. I’m concerned about what we have in terms of a policy, compliance with that policy, and engagement with that policy. We need to sort this out. So this last clip is saying to me that they recognise the importance of understanding if things are getting. Are things improving? And that can only be assessed through measurement and repeatedly measuring as things are getting better. So I hope that this has set the scene for the rest of this week’s MOOC. Measurement is important. As Kelvin said, “To measure is to know.”