Here are 16 typical hospital business process KPIs in two categories, according to the

whitepaper:

Inpatient flow
1. Inpatient raw mortality rate
2. CMS core measures
3. Harm events per 1,000 patient days
4. Bed turnover
5. Readmission rate
6. Occupancy rate
7. Average length of stay
8. Average cost per discharge
9. Patient satisfaction

Revenue cycle
10. Total operating margin
11. A/R days due to coding
12. Total A/R days outstanding
13. Total A/P days outstanding
14. Cash receipt to bad debt
15. Claims denial rate
16. Days of cash on hand

4. 25 Healthcare Metrics & KPIs

Operations

1. Patient Wait Time: Calculates the average amount of time a patient must wait between
checking in and seeing a provider. This can help with staffing and scheduling and provide
insight into patient satisfaction.

2. Average Number Of Patient Rooms In Use At One Time: Shows how well space is used
to treat patients and helps determine if more or less space is needed in the facility.
Think about this as an occupancy rate, like at a hotel.

3. Staff-To-Patient Ratio: Indicates the use and capacity of staff resources, which can
affect the quality of patient care.

5. Bed Or Room Turnover: Demonstrates how fast patients are moving in and out of the
facility. This affects the efficiency of the facility and should be considered when looking
at patient satisfaction. You might want to consider tying this one closely with
readmittance rates to make sure you that you are not letting people leave the facility
who are not well.
 5. Communication Between Primary Care Physician, Proceduralist, & Patient: Determines
how frequently various parties are in communication with one another, increasing the
quality of care for the patient. This is sometimes measured by satisfaction, and
sometimes measured by the number of documented communication activities.

Finance

6. Average Insurance Claim Processing Time & Cost: Averages the amount of time and
money an organization spends processing insurance claims. When low, it indicates that
the facility receives payment faster and there is less cost to the patient.

7. Claims Denial Rate: Provides insight into the effectiveness of the organization’s revenue
cycle. A low claims denial rate means that the organization has more time to focus on
patient care and spends less time on paperwork.

8. Average Treatment Charge: Shows the average amount that a facility charges a patient
for a treatment. It can be broken down by treatment or shown as an average of all
treatments or treatment categories.

9. Permanent Employee Wages: Records the value of wages (including bonuses) paid to all
full-time employees during the reporting period. This is sometimes separated out by
administration, and sometimes by direct providers of care.

Communications

10. Number Of Media Mentions: Keeps track of how often you’re mentioned in the media,
which could include news outlets as well as social media. You may want to consider
tracking positive and negative mentions separately.

11. Overall Patient Satisfaction: Calculates satisfaction levels by combining several factors.
This can be a great marketing tool for your organization if it’s high, but a low number
could signal a problem with other operations or services.

12. Percentage of Patients Who Found Paperwork To Be “Clearly Written &

Straightforward”: Demonstrates whether a healthcare organization has ensured that
written materials have clear instructions that patients can understand easily and
respond to.

Internal

13. Trainings Per Department: Tracks the amount of training each department provides or
requires of their staff.

14. Number Of Mistake Events: Measures the number of mistakes made in the
organization, which can be tracked by mistake category. This can indicate the
effectiveness of the employees and the equipment.
 15. Patient Confidentiality: Measures the number of times a patient’s confidential medical
records were compromised or seen by an unapproved party.

16. Number Of Partnerships With Advocacy Groups: Counts the number of relationships
established with other organizations. A high number of partnerships can increase the
impact of campaigns and policy events.

Public Health

17. Childhood Immunizations: Demonstrates the number of children who have received
immunizations, which reflects your contribution to overall community health.

18. Number Of Educational Programs: Indicates the time and effort put into educating the
public. This can be broken down into the type of program as well as the target audience
for each program.

19. Number Of Preterm Births: Counts the number of preterm births (under 37 weeks) that
have occurred in the region.

Emergency

20. Patient Wait Times By Process Step: Shows the amount of time a patient must wait
during their visit to the emergency area of the facility.

21. Time Between Symptom Onset & Hospitalization: Gauges the amount of time between
when a patient begins experiencing symptoms and when they were hospitalized.

22. Number Of Visitors (Patients) Who Leave Without Being Seen: Indicates the number of
people who were unwilling to wait to see a physician. This may help determine if more
beds or staff are needed to handle the number of patients coming in.

Care

23. Medication Errors: Measures the number of times there is an error in prescribing
medication at the facility. This includes when a mistake is made in the medication,
patient, or dosage, and it applies to both inpatient and outpatient services.

24. Patient Vs. Staff Ratio: Demonstrates the number of staff available per patient. May
indicate whether the facility is overstaffed or understaffed.

25. Patient Follow-Up: Measures the number of patients who receive follow-up after their
visit to the facility. This could be from a physician, nurse, or other staff member asking
about the visit and the patient’s improvements.
http://www.beckershospitalreview.com/hospital-management-administration/the-hospital-
ceo-s-ultimate-dashboard-what-to-check-daily-quarterly-and-yearly.html

Metrics and issues to monitor daily

One quick note before I dive in: In a LEAN environment the CEO might make these actions part
of his or her Leader Standard Work list.  

1. Outpatient no-shows. Patient no-shows hurt productivity and cost the healthcare industry
billions each year. If you notice your hospital's numbers are running high, it might be time to
tweak your reminder system or switch to a better one.

2. First case start-times. Prompt start times are crucial for preventing delays and bottlenecks,
and for keeping the OR running smoothly.

3. Patient volume. How many admissions are in the hospital each day?

4. "Door-to-doc" time in the emergency department. How long do patients wait to be seen by a

physician or advanced practice provider in the ED? This has implications for staffing levels,
patient safety, and patient and employee satisfaction. This metric, those regarding the following
two items and those regarding wait times for certain other care processes are available to the
public on Medicare Hospital Compare. Patients will compare your wait times with those of your
competitors to decide which hospital to visit.

5. "Decision to admit to departure" time in the ED. How long does it take from the time the
emergency physician decides to admit a patient to an inpatient bed to the time the patient
actually leaves the ED for that bed?

6. Number of patients who leave without being seen in the ED. Studies have shown LWBS visits
are an indication of ED crowding and are associated with longer ED wait times. Patients who
leave the ED without being seen are more likely to report worsened health problems.

7. Agency and overtime costs. It's important to look at agency costs constantly, because when
you use agencies you pay a premium price for hospital labor. This may be a temporary cost if
labor is assigned for a certain project, but most of the time, high agency costs mean the hospital
has a turnover issue, a recruitment issue or — most often, in my opinion — a retention issue. All
three of these are strongly correlated with employee engagement issues. Those who have high
agency costs, might also have lower patient experience costs because there are employees who
don't know each other and aren't familiar with the health system.

8. Major service issues. Are any patients upset? If so, it may be a good idea to handle these
situations personally.
9. Major engagement issues. Are any physicians or employees upset? This is the time to address
major issues in employee or physician morale. Employee engagement affects patient safety and
process improvement. That one number can impact all sorts of things. I would suggest employee
and physician satisfaction be regular agenda items at your department head and medical
executive committee meetings.

Metrics and issues to monitor quarterly

While most of these issues need to be looked at continually, I recommend an intensive review of
them at least four times a year.

1. Quality metrics. How are the hospital's HCAHPS results? Process of care measures? Outcome
measures? Pay-for-performance changes make these benchmarks particularly "hot," as they are
directly linked to the health of hospitals' operating margins.

2. Employee metrics. Are employees satisfied? How are turnover rates? Employee engagement
is essential to high-performance organizations. I suggest holding employee forums quarterly to
give employees a chance to be heard.

3. Physician metrics. This includes referral patterns as well as satisfaction ratings. It's important
to ensure physicians are deeply engaged in hospital operations and that they see your
organization as a great place to practice medicine.

4. Philanthropy. While most organizations zero in on philanthropy once a year, quarterly is

better in a time when so many hospitals are struggling to sustain themselves. With government
funding getting harder and harder to obtain, philanthropy grows more important. Keep an eye
on donations. Know when donations increase and decrease, and understand why. Also, keep the
lines of communication open. It's important to provide the people who donate money with
regular feedback on where their funds went.  

5. Board communication. I put this one in the "quarterly" bucket, but it should probably happen
more frequently than that. Communicate with key board members vigorously and often. The
end of the year is too late. Most hospital CEOs are never formally measured on board
communication. They assume that going to board meetings is enough, but it isn't: if there's a
problem, it festers and will one day explode. The CEO should meet with every board member
individually to ask what he or she defines as healthy communication. This is about clarifying
expectations and measuring them so the CEO is not surprised when an issue comes to head.

Steps to take annually

1. Hold an intensive leadership assessment. How aligned are your leaders in terms of mindset
and resources? Is there a universal sense of urgency regarding the need for constant
improvement? Are you taking the right actions quickly and precisely? What about your systems
and processes — do they hold people accountable for executing well? Studer Group offers the
Straight A Leadership Assessment to evaluate leaders, but if you don't use this tool, find another
way to measure these vital leadership issues.

2. Audit your evaluation system. How well do leader assessments match up to the results
they're responsible for? If most of your leaders receive a "substantially exceeds expectations"
rating, your organization needs to be hitting most, if not all, of its goals. I find this is often not
the case. If you're using a subjective evaluation tool, rather than an objective one linked to hard
goals, it may be time to re-think your approach.

3. Evaluate vendor contracts. Look closely at these relationships in two areas: cost and
performance. A while back, I was talking to a hospital CEO who was preparing for a reduction in
force at his organization. I pulled up the hospital's HCAHPS results and saw the organization was
in the 12th percentile for cleanliness. Its environmental services were outsourced. I would have
reevaluated that contract in a minute. Monitor the vendor costs — not only the market price
but the cost in terms of performance. Remember, hospitals can tie performance into their
contracts with vendors. It's common in certain areas, but could be common in more.

Conclusion

As I was writing this article, I struggled with whether to put "daily" items or "annual" items in
first position. I decided on daily, and for a reason. If you are truly monitoring these crucial issues
every day — and making smart decisions based on the evidence you're seeing — your quarterly
and annual tasks will be much, much easier. Throughout the year, you will build a solid
foundation for your annual tasks, and you'll be deeply familiar with the issues.

Together, these checklists make up a "dashboard" that will help hospital CEOs steer their
organizations confidently through the hurricane of change that's buffeting our industry.

I urge you to pay close attention to your dashboard. Sometimes, hospital CEOs don't want to
measure these issues when they anticipate a poor score or outcome. For example, if they sense
poor physician morale, they may want to avoid measuring it and validating their fear. Or CEOs
don't pin down the metrics in order to avoid conflict with the board. They anticipate that board
members will not be pleased with the results, and they want job security.

CEOs need to look at these metrics as if they were physicians. Physicians do not simply tell
patients they don't want to measure their blood pressure. It has to be done. Keeping tabs on the
health of your organization has to be done, too. It may mean enduring some discomfort up front
and learning a new habit — but when you experience the long-term gains in your organization's
health, you'll be glad you did it.