performance indicators in healthcare

1. Healthcare Operations Management
Module Title : Healthcare Operations Management
Level of Study : CIQ Level -7/ Postgraduate
By Dr.Syed Raza, MD, MRCP,FRCP,CCT,FACC,FESC
PG Dip. HCM , American Board in Medical Quality

2. Objectives to cover (LO3)
1. Review of performance indicators
2.Clinical and non -clinical metrics to enhance organizational
performance in healthcare setting
3. Patient satisfaction

3. Process and outcome measures
Measures of healthcare performance can be process or outcomes
measures.
– Process measures answer the question, “Are we doing the right
things?”
– Outcomes measures answer the question, “Are we doing the right
things well?”

4. ‘’ You cannot manage
what you cannot measure’’
-Peter Drucker

5. Why Measure?
To provide facts by which to manage
• To take advantage of the reality that people pay
more attention to facts
• To help make decisions based on fact
• To help prioritize opportunities for improvement
• To recognize successes
• To evaluate performance

6. KPIs vs. Metrics: Know the Difference
• A key performance indicator is used to measure performance and
success.
• A metric is nothing more than a number within a KPI that helps track
performance and progress.

7. Key Performance Indicator
• Key Performance Indicator measures performance or outcome .
• In a healthcare setting this is achieved by using clinical and non-
clinical metrics
• Healthcare organizations use a number of metrics to assess
performance and achievements.

8. What are essential components of KPI ?
CURRENT VALUE METRICS TARGET VALUE

9. • Indicators can measure structures, processes or outcomes of
health care.
• Clinical performance indicators are usually based on rates
measured or significant (critical) incidents in patient population
(ie. using clinical metrics)
• Non-Clinical performance indicators are based on metrics
that measures service delivery, operational cost, profit etc.

10. Common metrics in Healthcare
• Average Length of Stay
• Time to service.
• Hospital Incidents.
• Patient Satisfaction.
• Physician performance.
• Patient readmission rate.
• Operating Margin.
• Bed Occupancy Rate.

11. Common metrics in Healthcare: contd.
• Patient Drug Cost per stay
• Medical Utilization rate
• Turn around time for medical reports
• Waiting time
• Staff to patient ratio
• Cancelled / missed appointments

12. A KPI should be based on the following
principles:
• Implement a specific objective for each KPI.
• You must be able to measure your progress (or lack thereof) over a
specific period of time.
• The best KPIs are those that can be attained with a reasonable level
of effort.
• Results (such as the metrics you measure) should be related to your
goals.

13. What is hospital quality metrics ?
Hospital quality metrics are a set of standards that are developed to
quantify healthcare processes, patient outcomes, and organizational
structures which reflect the quality aspect of that hospital.

14. Examples of clinical metrics in KPI
• Average Length of Stay.
• Patient readmission rate
• Hospital acquired infection rate
• Post op complications
• Physician performance.
• Blood transfusion reaction
• Development of bed sores in admitted patients

15. Examples of non-clinical metrics
• Patient bed occupancy turn over / bed occupancy rate
• ER waiting time
• Discharge order to actual discharge time
• Lab reports turn around time
• Time from purchase order to procurement of order
• Operational cost
• Profit margin

28. Sentinel Event Indicators
An adverse sentinel event is defined as “an unexpected occurrence-
involving death or serious physical or psychological injury, or the risk
thereof”

29. Rate based indicators
• Unlike sentinel event indicators that identify single occurrences, rate-based
indicators are used to monitor many events or a process over a specified
period of time.
Caesarean sections
Late discharges
Wound infections
• Rate-based indicators measure the proportion of occurrences or events in
relation to the population at risk. To determine the rate, divide the number
of occurrences (numerator) by the number of individuals at risk
(denominator)

30. Required performance measures (JCIA)
• 1. All adverse events or patterns of adverse events occurring during
anesthesia use, including sedation of patients while the patients are
conscious
• 2. Processes and outcomes related to behavior management,
including (when possible) the perceptions of the patients or
individuals served, their families, and the hospital’s clinical staff
• 3. Appropriateness of admission and continued stays (i.e., utilization
management activities)
• 4. Significant adverse drug reactions

31. Required performance measures : Contd1
• 5. Processes and outcomes related to surgery and invasive or
noninvasive procedures
• 6. Processes and outcomes related to blood usage
• 7. Appropriateness, completeness, and timeliness of health record
documentation

32. Required performance measures : Contd2
• 8. Information solicited from patients and individuals served, their families,
hospital staff members, and others about how well the organization is
meeting needs and expectations, the level of satisfaction with the
organization, and areas where the organization could improve
• 9. Competence of all staff, including licensed independent practitioners
• 10. Risk-management activities
• 12. Quality control activities covering the following services: clinical
laboratory. nutrition, equipment used in administering medication, and
pharmaceutical equipment used to prepare medication (only those
services provided in the organization)

33. PATIENT CENTERED STANDARDS
• Access to Care & Continuity of Care (ACC)
• • Patient & Family Rights (PFR).
• • Assessment of Patient (AOP)
• • Care of Patient (COP).
• • Patient & Family Education (PFE)

34. Healthcare Organization Management
Standards
• Quality Improvement and Patient Safety (QPS)
• • Prevention and Control of Infection (PCI)
• • Governance, Leadership and Direction (GLD)
• • Facility Management and Safety (FMS)
• • Staff Qualification and Management (SQE)
• • Management of Information (MOI)

35. Goal Metrics
Metrics that organizations utilize to measure performance goal using
or testing certain strategy or planning.

36. Qualitative Metrics

37. Quantitative Metrics

38. Actionable Metrics

39. Informational Metrics

40. Vanity Metrics

41. Process and Outcomes Measures for Outpatients
with Diabetes Mellitus
• Process measures – Rate of glycosylated hemoglobin testing – Percent of
patients self-monitoring of blood glucose – Rates of dilated
ophthalmoscopic examination – Rates of foot examination
• Outcome measures – Average value of glycosylated hemoglobin testing –
Hospitalization rates – Percentage of patients developing foot ulcers

42. Peri-operative Indicators
• CNS complication occurring within two post-procedure days of procedures
involving anesthesia administration
• Patients developing an acute myocardial infarction within two post
procedure days of procedures involving anesthesia administration
•
• Intrahospital mortality of patients within two post-procedure days of
procedures involving anesthesia administration

43. Cardiovascular Indicators
• Focus: Extended postoperative stay post CABG
-- number of days from- surgery to discharge
• Focus: Timing of thrombolytic therapy administration
--- Door to needle time
• Focus: Diagnostic accuracy
---- Numerator : Patients with principal discharge diagnosis of congestive
heart failure (CHF)
Denominator : All patients with SOB suspected of CHF

46. Patient satisfaction

48. Ways to measure patient feedback

50. What should be measured ?
• What are the patients’ expectations?
• What aspects of patient satisfaction should be measured? How can these
aspects be measured?
• For outcomes related to key quality attributes: What evidence is available
to demonstrate whether the care or service provided have met the
patients’ expectations and/or current professional standards?
• Which outcomes are most important to our patients?
• How can these be measured ?

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