Descriptions of the structure and flow of a system must be supplemented with measures of its performance over time. This provides a basis for learning about what aspects of the system are responsible for improved performance. An improvement team should perform three tasks to thoroughly determine the performance of the system under study:

• Develop a set of measures for the system that balances the consideration of clinical outcome, patient and staff satisfaction, and cost
• Determine whether changes to the system result in improvement by plotting the set of measures over time
• Understand which variation in the time series strengthens the evidence that the changes have improved performance

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