Equity Dashboards in a Statewide Surgical Quality Collaborative: A Mixed Methods Pre-Implementation Study

Collaborative quality initiatives have leveraged performance dashboards and cross-institutional learning to improve surgical outcomes. However, these models for quality improvement have yet to integrate tools for improving health disparities. In this mixed-methods pre-implementation project, we assessed the interpretability and utility of health equity dashboards in a statewide quality collaborative.

This mixed methods study was guided by the Theoretical Domains Framework (TDF). Stakeholders from hospitals participating in the Michigan Surgical Quality Collaborative (MSQC) were recruited for a survey (n = 105) or focus group (n = 6). The survey assessed knowledge, clarity, and usability of a health equity dashboard. Focus groups provided in-depth qualitative feedback on a site-specific health equity dashboard. We integrated a content analysis of survey results and thematic analysis of focus groups.

There were 105 survey respondents. Perceived clarity of the dashboard was high (73/105, 70% agree or strongly agree information is clear and understandable), but misinterpretation was common (46%-49% incorrect interpretation). Focus groups revealed sources of misinterpretation as a lack of familiarity with exposure variables and uncertainty about the meaning of results. Respondents reported a high likelihood of dashboard use (71/104, 74% somewhat or extremely likely to use) and expressed optimism about potential uses and belief in the importance of the work. However, key barriers from participants included limited experience with equity dashboards, concerns about data integrity and representation, and the need for additional tools to enable actionable change.

This work identifies key factors that influence the successful implementation of health equity dashboards, providing valuable insights to strengthen infrastructure within learning health systems and advance equity-conscious quality improvement.