Ill start with a Cliche – “What is not measured is not done”, but i truly believe in the power of measurement and that’s why measuring all that you have envisioned for your hospital becomes critical. But then how good are our hospitals at measuring?
Before we can really answer that question we need to identify what it is exactly that we our measuring. I have come across a few discussions which were based entirely around what hospitals should measure and honestly every individual seems to have his / her own response. Yes there are some basic KPIs such as ALOS , Occupancy, Revenue etc that keep cropping up from time to time however I haven’t really come across a really well defined KPI directory that you can choose from . And sadly enough some rare managers and administrators that I have come across are not even aware of the entire implication that a particular KPI has on the functioning of the hospital.
My attempt here is not to define a directory for you but rather to set a direction to our way of thinking about KPIs
So what do hospitals measure?
Our entire KPI classification is based around
Clinical Quality – e.g. Medication errors, outcomes, mortality, hospital acquired infection , repeated surgeries, readmissions etc
Operational Quality – e.g. waiting times, Going above estimates, Consultation quality, Discharge times, Admission times etc
Operational efficiency – e.g. ALOS, Volume growth, Cost per bed, Material cost %, utilization rates, Your basic time motion studies regarding process efficiency etc
Financial health – eg. EBITA, Debtors outstanding, Case mix, Revenue source mix, Cash to debtor’s ratio, Cash flow etc.
This is definitely not all inclusive in terms of KPIs or categories but basically top of the head stuff. I have also seen people merge Operational quality and efficiency but id rather keep them separated.
Wow that’s quite a lot of things to measure if you think about it and we haven’t even quite scratched the surface yet. How will I keep an eye on the ball when I’m being bombarded with balls? The answer my friend is simple identify what’s important for you
So what is important for you? Prioritise
The KPI dashboard that you are most concerned about is directly related to the level / nature of involvement that you have with the organization.
If you are a C level executive your KPI dashboard might be entirely different from let’s say someone related solely to Operations which might be different from the individual heading Quality. When i say different it doesn’t mean there is no overlap there will be overlaps but functionalities are different.
So a CEO would have some of these things on his / her mind – EBITA , Material Expenditure, Volumes for critical procedures , Case Mix , ALOS, Debtors , Utilization etc.
And then this further would percolate down to departmental levels. Eg OPD would have different Performance indicators such as waiting times, doctor punctuality, material consumption, Staff attendance, Overtimes, Complains, average consultation times, volumes, etc .Marketing would have measures like – call volunmes, sector wise revenue, cost per customer acquisition , doctor wise performance, activity vs conversion etc
I would say define your parameters well at the departmental levels to drive true quality and efficiency.
Ideally a C level manager should look at about 30 – 50 selected indicators on a daily basis and then selectively look at indicators from departmental levels which show huge discrepancy from the expected values or unusual results. Focus can also be shifted while working on specific projects. Please note it’s difficult to keep an eye on 170 parameters so prioritise and reorganize your dashboard on regular intervals
At the departmental level each department should be encouraged to develop their own KPI bout 20 – 30 against which they measure themselves. Please remember while defining your KPI it’s important to understand why you are measuring it and whether you need to include it, be specific and be selective. Also VOC (voice of customer) must be imbibed into your Dashboard structure. Lastly identify the correct method to measure the KPI you are defining a lot of times time is wasted on goose chases with either the wrong data or erroneous data collection.
This is the tough part here is where you record, review and correct and this is not only for a particular phenomenon that you are measuring but also your dashboard structure add omit and refine the dashboard as you go along. But before that i can not stress on the importance of getting the message across to your entire hospital team. The grass root level must understand the importance of an entry they make or the data they capture to ensure the quality of data and the success of the system.
What would be the benefit?
The answer is simple consistent quality service provided with efficiency and accuracy.
HIS / BI Tools
I am certain there are quite a few HIS systems as well as Business Intelligence tools which integrate with your HIS systems to raise alarm and to bring things to your notice. However treat them as tools but don’t be over dependent on them. Because solutions which come in a tin are not necessarily the solutions we need.
My overall experience with KPI mapping in hospitals in India is that we are inept at measurement. Most hospitals basically follow a basic set of indicators that are commonly predefined and taught in Hospital Management courses, however creative development of newer indicators seems rare. A problem that is causing this is that management professionals are not necessarily keen at sharing their knowledge, and the knowledge share which happens is mostly of data which is already out there in the public domain. Also as an industry there is a lot to learn from the Manufacturing sector and we must keep our minds open to newer possibilities through cross industrial / sector learning. In the end Collective Cognition is the need of the hour.
Disclaimer: The views expressed in this post are my own and are not meant to be derogatory to any institution or organisation. These are just my thoughts and these are open for further discussion and development. Please do comment and share and let’s get some universal cognition into this. Thank you for your patience and tolerance.