Counting sheep – my antidote to measurement fatigue !


When I’m teaching I usually have a ‘good think’ about which bit of measurement for improvement I am going to start with when I’m working with a new group of learners. How to make it easy enough for people to give it a go… but not so easy that they think they won’t need to learn and practice it- because they will need to do just that!

To get people started I usually recommend a ‘10 minute watch’ of Mike Davidge’s excellent Youtube video: 7 steps to measurement.

In it Mike takes you through many of the challenges. Step 1: the measurement aim which will relate directly to your overarching improvement aim (in the model for improvement) Step 2 – choose measures is interesting because the people I meet often start with measures that are actually quite difficult and time consuming to collect – when there are actually much simpler ones around. To see what I mean check out this great example from ELFT’s recent article on How easy is it to collect data during quality improvement work?

I always encourage people to be as creative as they can in listing things they can measure before choosing one – this way you’ve got a better chance of finding one that’s within your reach!

Step 3 is about defining your measure, and you might wonder why this is so important? Well, quality improvement is a team endeavour. And if we want to progress, we need to be able to share the workload around the team. This applies to collecting measures as much as it does to generating good ideas for measurement– but in this step you need to replace creativity with rigour to create a definition that provides a robust and repeatable measure.

And this is where I found the inspiration for my antidote in a story told by Andrew Dilnot and Michael Blastland (of Radio 4’s More or less fame) in their lovely book The Tiger That Isn’t: Seeing Through a World of Numbers  

The challenge here is to describe the number of sheep.

And like all things to do with improvement science – it can seem at first deceptively simple.

But by appreciating that we all live our lives by different mental models, you can see how the count can vary depending on our very personal definition of ‘a sheep’! And this is such a great and memorable example of WHY we need to get a good definition – so that we can rely on the data – whoever collects it!