The ACE @ 25 programme is a clinical balanced scorecard used by Apollo Hospitals that incorporates 25 clinical quality parameters across major specialties. It benchmarks outcomes against top international hospitals and provides weighted scores on outcomes. The programme aims to improve clinical excellence across Apollo Hospitals by measuring and monitoring key quality indicators. It provides a centralized online platform for 33 Apollo Hospitals to enter, track, and improve their performance on core clinical metrics.

1. ACE @ 25 - APOLLO CLINICAL EXCELLENCE SCORECARD
Brief description of the programme / project / initiative
ACE @ 25 is a clinical balanced scorecard incorporating 25 clinical quality parameters involving
complication rates, mortality rates, one year survival rates and average length of stay after major
procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel
resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain
satisfaction and medication errors. Parameters have been benchmarked against the published bench
marks of the world’s best hospitals including Cleveland Clinic, Mayo Clinic, National Healthcare Safety
Network, Massachusetts General Hospital, AHRQ US, Columbia University Medical Center and US
Census Bureau. There are weighted scores for outcomes color coded green, orange and red. Cumulative
score is 100.
ALOS post angioplasty 2.5 Days ≤ 2.5 4
Hillcrest Hospital
2.51-3.00 3
Cleveland Clinic
3.01-3.50 2
3.51-4.00 1
>4.00 0
Figure 1: A parameter from ACE @ 25, the benchmark and scoring
Data is reported monthly by 33 Group Hospitals online on the Apollo Lighthouse platform (SQL based
front and DotNet based back end support). Login and passwords are provided to all hospitals for entering
the data. The data is entered by the hospitals and software automatically gives the scores and the color
coding. Data confidentiality is maintained with the hospitals having access to only their own data. The
collective data for all locations can be viewed by the Group leadership. Added security prevents
unauthorized entry to the data.
The Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board.
An audit team audits the data at all locations every six months. Scores are linked to appraisal of the
medical head and there is an “ACE @ 25” Champion Award for the highest scorer.
Why was the project started
Whatever is measured tends to improve. With a view to objectively measuring and improving clinical
quality across the Apollo Group Hospitals, this huge initiative of ACE @ 25 was launched in Jan 09.
Clinical excellence is a core requirement for successful performance of any healthcare organization. It
cannot be emphasized enough that clinical excellence is probably the most vital and differentiating factor
for people to choose their hospital. Clinical Excellence is a synthesis of several dimensions such as
clinical skills, usage of evidence based methods of care, effectiveness of care, efficiency, patient
centeredness and safety. These dimensions can be successfully achieved only with system-wide change
resulting in continuous improvement. ACE @ 25 envisaged improvement in all of these processes
through concerted efforts by individual care providers and by the management, thereby improving clinical
quality. It encompassed credentialing and privileging, measuring individual consultant clinical
performance, implementing clinical pathways and clinical practice guidelines, streamlining discharge
processes, implementing infection control measures and pain management strategies, training and more.
Objective
The objective of the project is to bring scores of all parameters for all hospitals to the green zone.
Target group

2. The target group was Apollo Group Hospitals and all patients visiting Apollo Hospitals benefited by this
clinical excellence initiative
Geographical reach
33 national and international Apollo Group Hospitals
Date from which the project became operational
1st January 2009
10 points that make the programme / project innovative?
1. First clinical excellence scorecard in India based totally on IT application.
2. Clinical excellence scorecard connecting 33 hospitals
3. Volume of data – 25 clinical parameters monitored and reported every month by 8 Group A
hospitals, 15 parameters by 10 Group B hospitals and 10 parameters by 15 Group C hospitals
4. Totally online data
5. Statistical color coded scores, hospitals feed in data, system automatically assigns the scores
and the color codes
6. Confidentiality of data maintained, hospitals can view only their own data
7. Leadership can view data for all parameters for all hospitals at any time
8. All data audited through Central audit team twice a year
9. Centrally monitored action plans to improve scores falling in red
10. Performance linked to medical head’s appraisal
List the 5 achievements of the programme / project?
1. Clinical quality data available for 33 Apollo Hospitals at one time at one site for internal as well as
external comparison
2. No paper transaction involved in the whole process
3. All data collected through standardized definitions and processes across the Group
4. 7.3% increase in average scores over the last year - improvement in infection rates, medication
error rates, mortality rates, complication rates and average length of stays in various hospitals
5. All hospitals data audited – 85% standardization achieved

3. List the 5 key challenges faced while implementing the programme / project / initiative and how they were
overcome?
1. Bringing hospitals varying in size, number of specialties and location under one umbrella for
reporting a clinical excellence dashboard. It was overcome by categorizing hospitals into Group
A, B and C based on bed strength, city and specialties provided. Group A hospitals reported 25
parameters, Group B 15 parameters and Group C 10 parameters. Two parameters for each
location were location specific and the rest were common with the other Group hospitals.
2. Selecting parameters covering all major specialties, choosing benchmarks from world renowned
hospitals, devising a scoring pattern, color coding the outcomes, drawing standardized
definitions, numerators and denominators, exclusions and inclusions. A core team of clinicians
and hospital administrators was formed who took four months to draw the dashboard without any
external help. The vastness of information on the net was used to its full potential.
3. Developing software for data upload on a single site by all hospitals with variable parameters and
maintaining confidentiality and security of data while providing access to all data to the Group
leadership. The corporate IT team at Apollo undertook the task of developing and implementing
ACE @ 25 online, with live capabilities using our ‘Apollo Lighthouse’ platform (SQL based front
and DotNet based back end support) for monthly inputs with relevant data. The mechanism is so
devised to maintain the integrity and confidentiality of data with respect to each of the Apollo
Hospitals. It has been provided with an added layer of security over the web, lest it is accidentally
accessed by any unauthorized personnel.
4. Implementing standardized processes for monitoring of data, deploying the necessary resources
and personnel. For this ACE @ 25 was made a part of medical head’s and operational head’s
appraisal to impress the focus of the leadership on attaining and maintaining the best clinical
outcomes for the patients.
5. Ensuring accuracy of data reported. Data validation by a team of 20 auditors who audit the data
twice a year based on an audit guide, auditor training and audit reporting templates.

4. List the 5 points how can the programme serve as a model that can be replicated or adapted by others?
1. It covers published clinical quality parameters from all major specialties in hospitals, with
definitions, numerators, denominators, inclusions and exclusions
2. It uses published international benchmarks to achieve
3. It is totally online and doesn’t involve any paper transfer
4. It involves a meticulous audit mechanism to ensure standardization of data collection
methodology and authenticity of data
5. It involves a rigorous follow up mechanism for improvement of scores and also for rewarding
good performance.
List 5 points to elaborate on the scalability of the programme / project / initiative
1. All hospitals and hospital groups can monitor their clinical outcomes through online dashboards.
2. It shall allow the hospitals to undertake an internal and external comparison with national and
international benchmarks and make improvements
3. Hospitals could share their best practices involved in achieving the clinical excellence
benchmarks and what interventions worked best for them.
4. Information by all hospitals could be made available to and audited by an independent body.
5. This information could be put online for all hospitals in India. It would be a valuable resource for
the patients and insurance companies in choosing their hospitals.