KPIs for Effective,

Real-Time Dashboards in Hospitals

Abstract
The disparate and disjointed data silos across various hospital departments
constitute the biggest decision-making bottleneck. They impede the gathering
of real-time, actionable information about the hospital’s performance with
regard to clinical, operational and financial key performance indicators
(KPIs). Most hospitals have business intelligence (BI) systems which provide
post facto analysis and miss out on the real-time aspect. In such situations, the
hospital’s executives depends on more than one system to get any actionable
data and is thus stymied in taking effective, problem-solving steps.
Dashboards generated by the BI systems and used by hospital administrators
need to gather data on KPIs from varied sources in the facility and present
a holistic view. With such data aggregation, a COO can obtain a real-time,
360-degree snapshot of the hospital’s performance and take proactive decisions.
At the same time, a dashboard must drill down into each of the KPI details
to identify and eliminate the root causes for poor performance. In this paper
we present our point of view on crucial hospital KPIs, how a dashboard can
accelerate the speed and quality of decision-making and how it must present
information.

For more information, contact askus@infosys.com

Mar 2009
Introduction
Hospital’s executives must perform the complex task of keeping pace with the dynamic healthcare environment – constantly
changing patient volumes, fluctuating supply costs, stringent government compliance and quality requirements, asset
utilization needs, and staffing shortages. To take the informed decisions that help the hospital maintain a competitive
advantage, COOs need real-time actionable information at their finger tips. The disparate silos of data across various
departments are the biggest bottleneck in providing actionable information. Mergers and acquisitions add to the diversity of
hospital information system (HIS) application and data sources, thereby not allowing ‘one version of truth’ about hospital
performance to emerge.
The need of the hour is to have an IT solution which can fetch data from all disparate data sources and present it in an
intuitive form to a COO, all in real time. In this paper, we present our point of view on the information and features hospital
COOs need to help them make informed decisions.

What information should a COO dashboard give and why?

Hospital’s executives need to concentrate their energies on monitoring KPIs that are aligned with hospital goals. However,
in this competitive environment, all hospitals have common goals of proving quality care at a reasonable cost. The most
common KPIs which should be looked at are:

Type Key KPIs Drill down KPIs How does it help a COO
CLINICAL Hospital No. of patients acquiring A COO gets a quick snapshot on how the hospital
incidents infections, Transfusion is performing with regard to the quality of care. The
These have a
reactions, Bed sores, drill down information provides insights on factors
high impact on
Postoperative respiratory that need immediate corrective action.
the outcome
failure, Postoperative
E.g.: If transfusion reactions are high, a COO may
pulmonary embolism or
want to look at the revising the blood transfusion
deep vein thrombosis,
policy by adding checklists or improving compliance
Postoperative sepsis,
to standard operating procedures (SOPs).
Postoperative hip fracture,
Postoperative hemorrhage or
hematoma.
Death rate Postoperative death rate, Nation- and state-wide mortality rates are published
Post-procedural death rate by government bodies. A COO can benchmark
the performance of the hospital and see how it has
performed against national and state averages and
also against its competition.
Patient Courtesy score for staff, Patient satisfaction data provides valuable insights
satisfaction Quality of meals, Quality of into making adjustments in areas such as efficiency
physician care, Quality of of the admissions process and managing admission of
nursing care, Housekeeping patients to a clinical unit. It is
score,

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Type Key KPIs Drill down KPIs How does it help a COO
OPERATIONAL Admission process score also valuable for staff training, morale-building
and creative marketing. It is an effective, two-way
These have a
communication – not only does the stress on quality
high impact on
alert patients that physicians are held accountable,
productivity,
but it also shows physicians that patients are pleased
employee
with the quality of care they receive.
morale,
and patient Medication error Wrong medication, Wrong Technology options like usage of computerized
satisfaction patient, Wrong dosage physician order entry (CPOE) and clinical decision
support systems (CDSS) for allergy prompts, wireless
patient identification and sensors can be deployed to
reduce medication errors.
Patient wait time Admission, Discharge, Triage, Patient wait time directly influences the patient
Ambulance, Diagnosis (Lab, satisfaction level. Such insight allows COOs to target
radiology) for improvement areas with higher wait times. Thus,
staff can be added, training conducted to increase
efficiency, and technology support provided for
enhanced productivity.
Average Length Admission (Last day/month A daily, weekly, monthly, quarterly census of
Of Stay (ALOS) to date/year to date) admission and discharge can provide insights into the
patient throughput for a hospital.
Discharge (Last day/month to
date/year to date) ALOS can drill down by diagnosis group, followed by
facility and insurance plan, to individual patients and
their hospital stays to provide insights into outliers.
ALOS is often treated as an indicator of efficiency. All
other things being equal, a shorter stay reduces the
cost per discharge and shift care from inpatient to less
expensive post-acute settings. However, shorter stays
tend to be more service intensive and more costly per
day. Very short stays can also cause adverse effect on
health outcomes, or reduce the comfort and recovery
of the patient. If this leads to a rising readmission
rate, costs per episode of illness may fall a little, or
even rise.
Asset utilization Bed utilization rate, Assets generate revenue only when they are put to
rate Equipment utilization time, use. Tracking the performance of all hospital assets
Equipment maintenance can have a huge impact on patient satisfaction and
time, Equipment idle time the bottom line. Low utilization levels lead to lost
revenue and a very high utilization level leads to
increased wait times, cancellations and diversions.

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Type Key KPIs Drill down KPIs How does it help a COO
FINANCIAL Payor % Claims paid Payor performance would provide insights into how
performance Reimbursements Amount payor contracts are performing and which one needs
These have a
Volume re negotiation.
high impact the
on top line and Physician Revenue per physician Physician performance provides insights into how
bottom line performance Reimbursements per each physician is performing in terms of number
physician of cases, revenue per case, utilization cost per case,
bonuses and penalties incurred per physician.
Hospital Revenue Profit Margin This would provide real time snap shot of the hospital
performance Clinical Cost Reimbursement performance in terms of Revenue, profit, margin,
AR aging days reimbursement vs utilization cost, AR by aging days
and potential high risk AR that need immediate
intervention.
Referrals to Diversion hours, Physician Ambulance diversions have a very high impact on
outside centers non-availability the clinical outcome and are a direct revenue loss to
the hospital. Efforts should be made to keep this to
minimum levels.
Expense Overtime hours, Test results Overtime hours provide an insight into capacity
incurred by error planning issues and have a direct impact on the
hospitals bottom line as well as employee satisfaction.
Test results errors result in lost revenue and resources,
impacting the bottom line. Cause analysis needs to be
carried out to reduce these occurrences.
Physician Revenue per physician, Revenue and reimbursements per physician provide
performance Reimbursements per details on how each physician and specialty is
physician performing. Bonus and reimbursements provide
an indirect measure of compliance with clinical
pathways and hospital SOPs.

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Characteristics of a good BI tool:
The hospital’s business intelligence and reporting tool, which collects, cleans and presents the data, must enable the following
features:
1. The KPIs need to be represented by:
• Facility
• Specialty
• Department
2. Trends must be highlighted whenever possible against:
• Benchmark targets
• Monthly, Quarterly, Yearly performance
3. A decision-support section must be available to: Good BI tool components
• Predict likely events based on trends, history and extrapolation
• Suggest adjustments needed to meet benchmark targets

Good BI tool components

4. All KPIs must have clear ownership and owner contact details. The drill down reports/charts should be easy to e-mail
and print.
5. Customized dashboard for quick access to information relevant to the specific user role.
6. Capability to access data feeds from other medical systems.
7. The tool needs to allow interoperability to enable corrective action by logging into the source system of KPI data.
8. Anytime anywhere access by allowing users to access screens over mobile.
9. Rule engine to configure alerts, escalations and decision support.
Today, visually intuitive and rich graphical dashboards such as the one shown in Figures below can dramatically accelerate
the speed and quality of the decision-making cycle. This is not just about making dashboards more pleasing to the eye, but
about users spending less time reviewing content and more time taking action. A dashboard should be information rich and
not data rich.

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Illustrative COO dashboard

Illustrative CFO dashboard

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Illustrative CQO dashboard around CMS P4P program performance.

Benefits accruing from information-rich dashboards

The key to effective performance monitoring is access to information-rich dashboards with real-time data from all disparate
hospital applications, coupled with decision support, alerting and escalation functionalities. The data’s source system must be
accessible for any actionable alerts (by providing a hyperlink in an alert mail to access source system) to initiate immediate
corrective action. Such a business intelligence tool helps cultivate proactive behavior among the care givers. With a clear
definition and representation of KPIs, information dashboards empower employees to actively make decisions that optimize
across various objectives and look for creative ways to achieve goals. Clear communication and feedback is established
around objectives and measures. After an effective BI dashboard implementation, typically hospitals have seen improvements
in:
• Adverse events and unplanned readmissions: 7% reduction
• Patient satisfaction: 15% improvement
• Staff overtime: 11% decrease