This document discusses key performance indicators (KPIs) and metrics for measuring healthcare operations management. It begins by outlining the objectives and levels of study for the module. It then defines process and outcomes measures that can be used. The document distinguishes between KPIs and the underlying metrics. It provides examples of common clinical and non-clinical metrics in healthcare like average length of stay, patient satisfaction, and operating margin. It also discusses quality metrics used by CMS and principles for effective KPI selection. Overall, the document provides an overview of how performance in healthcare can be measured using metrics and KPIs to enhance organizational performance.

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.Clinical and non -clinical metrics to enhance organizational
performance in healthcare setting
• 2. Patient satisfaction and process enhancement leading to cost
benefits
• 3. Review of performance indicators
• 4. Develop a model and recommend solutions for enhanced
performance
• 5. Team work

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. 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.

5. Key Performance Indicator
• Key Performance Indicator measures performance or outcome .
• In a healthcare setting this is achieved by using clinical and non-
clinical metrics

6. Key Performance Indicator

7. 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.

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

16. 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.

17. • 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.

18. What is hospital quality metrics ?
Hospital quality metrics are a set of standards developed by CMS to
quantify healthcare processes, patient outcomes, and organizational
structures.

19. Examples of clinical metrics in KPI
• Average Length of Stay.
• Hospital Incidents
• Patient Satisfaction.
• Physician performance.
• Patient readmission rate

20. Examples of non-clinical metrics
• Hospital length of stay
• Bed occupancy rate
• Operational cost
• Profit margin

21. 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”

22. 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
vaginal births after C-section
Unexpected deaths
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)

23. 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. Processes and outcomes related to the use of restraint and seclusion
• 4. Appropriateness of admission and continued stays (i.e., utilization
management activities)
• 5. Significant adverse drug reactions

24. Required performance measures : Contd1
• 6. Processes and outcomes related to medication usage
• 7. Processes and outcomes related to surgery and invasive or
noninvasive procedures
• 8. Processes and outcomes related to blood usage
• 9. Appropriateness, completeness, and timeliness of health record
documentation
• 10.Deficiencies, problems, failures, and user errors in safety
management, life safety management, equipment management, and
utilities management

25. Required performance measures : Contd2
• 11. Information solicited from patients and mdividuals 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
• 12. Competence of all staff, including licensed independent practitioners
• 13. Risk-management activities
• 14. 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)

26. 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)

27. 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)

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

29. Qualitative Metrics

30. Quantitative Metrics

31. Actionable Metrics

32. Informational Metrics

33. Vanity Metrics

34. The seven groupings of outcome measures CMS
uses to calculate hospital quality are some of the
most common in healthcare
• #1: Mortality
• #2: Safety of Care
• #3: Readmissions
• #4: Patient Experience
• #5: Effectiveness of Care
• #6: Timeliness of Care
• #7: Data Transparency

35. 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

36. Process and Outcomes Measures for
Outpatients with Diabetes MelIittis
• 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

37. Peri-operative Indicators
• Denominator: All patients undergoing inpatient procedures involving anesthesia (defined as
administration of general, spinal, or regional anesthesia or sedation) for which there is a
reasonable expectation that the sedation anesthesia will result in the loss of protective reflexes
for a significant percentage of patients (all settings, purposes, routes) 1. “Focus: Preoperative
patient evaluation, intraoperative and postoperative monitoring, and timely clinical intervention
Numerator: Patients developing a CNS complication occurring within two postprocedure days of
procedures involving anesthesia administration (subcategorized by ASA-PS class, patient age, and
CNS- versus non-CNSrelated procedures” 2. Focus: Same, plus appropriate surgical preparation
“Numerator: Patients developing a peripheral neurological deficit within two postprocedure days
of procedures involving anesthesia administration” 3. “Focus: Preoperative patient evaluation,
intraoperative and postoperative monitoring, and timely clinical intervention Numerator: Patients
developing an acute myocardial infarction within two post procedure days of procedures involving
anesthesia administration [subcategorized by ASA-PS class, patient age, and cardiac- versus
noncardiac-related procedures]” 4. Focus: Same “Numerator. Patients with a cardiac arrest within
two postprocedure days of procedures involving anesthesia administration [subcategorized by
ASA-PS class, patient age, and cardiac-versus noncardiac-related procedures]” 5. Focus Same
“Numerator: Intrahospital mortality of patients within two postprocedure days of procedures
involving anesthesia administration [subcategorized by ASA-PS class and patient age]

38. Obstetrical care indicators
• . Focus: Prenatal patient evaluation, education, and treatment selection Numerator:
Patients delivered by cesarean section Denominator: All deliveries 7. Focus: Same
Numerator: Patients with vaginal birth after cesarean section (VBAC) Denominator:
Patients delivered with a history of previous cesarean section” 8. Focus: Prenatal patient
evaluation, intrapartum monitoring, and clinical intervention Numerator. Live-born
infants with a birthweight less than 2500 grams Denominator: All live births 9. Focus:
Prenatal patient evaluation, intrapartum monitoring, neonatal patient eva1uatIc and
clinical intervention Numerator. Live-born infants with a birthweight greater than or
equal to 2500 grams, who have at least one of the following: anApgar score of less than 4
at five minutes, a requirement for admission to the neonatal intensive care unit within
one day of delivery for greater than 24 hours, a dinically apparent seizure, or significant
birth trauma Denominator: All five-born infants with a birthweight greater than 2500
grams* 10. Focus: Same “Numerator. Live-born infants with a birthweight greater than
1000 grams and less than 2500 grams who have an Apgar score of less than 4 at five
minutes Denominator: All live-born infants with a birthweight greater than 1000 grams
and less than 2500 gram

39. Cardiovascular Indicators
• Focus: Extended postoperative stay as a means of assessing multiple aspects of coronary artery bypass graft
(CABG) care Indicator Statement: Patients undergoing isolated CABG procedures: number of days from-
surgery to discharge Focus: Timing of thrombolytic therapy administration Indicator Statement: Patients
admitted through the emergency department who have a principal discharge diagnosis of acute myocardial
infarction (AM I) and ST segment evaluation on their initial electrocardiogram: time from emergency
department arrival to administration of thrombotytic therapy “Focus: Diagnostic accuracy Numerator
Patients with principal discharge diagnosis of congestive heart failure (CHF) with documented etiology
Denomator Patients with principal discharge diagnosis of CHF “Focus: Extended postprocedure Stay as a
means of assessing multiple aspects of percutaneous-transluminal coronary angioplasty (PTCA) care
Indicator Statement: Patients undergoing PTCA: number of days from procedure to discharge “Focus:
Intrahospital mortality as a means of assessing multiple aspects of coronary artery bypass graft (CABG)
patient care Numeratoar Intrahospital mortality of patients undergoing an isolated CABG Denominator
Patients undergoing an iso!ated CABGW “Focus: Intrahospital mortality as a means of assessing multiple
aspects of percutaneous transluminal coronary angioplasty (PTCA) patient care Numerator: lntrahospital
mortality of patients undergoing a PTCA Denominator: Patients undergoing PTCA “Focus: Intrahospital
mortality as a means of assessing multiple aspects of acute myocardial infarction (AMI) patient care
Numerator: Intrahospital mortality of patients with a principal discharge diagnosis of AMI Denominator:
Patients with a principal discharge diagnosis of AMI”

40. Oncology Indicators
• “Focus: Availability of data for diagnosis and staging Numerator. Patients undergoing resection for
primary cancer of the lung, colon/rectum or female breast for whom a surgical pathology
consultation report is present in the medical record Denominator: Patients undergoing resection
for primary cancer of the female breast, lung, or colon/ rectum. 17. “Focus: Use of staging by
managing physicians Numerator: Patients undergoing resection for primary cancer of the female
breast, or colon/ rectum with stage of tumor designated by a managing physician Denominator:
Patients undergoing resection for primary cancer of the female breast, lung, of colon/rectums 18.
“Focus: Use of tests critical for prognosis and clinical management of female breast cancer
Numerator. Female patients with American Joint Committee on Cancer (AJCC) Stage I or greater
primary breast cancer who, after initial biopsy or resection, have estrogen receptor analysis
results in the medical record Denominator Female patients with Stage I or greater primary breast
cancer undergoing initial biopsy or resection’ 19. “Focus: Effectiveness of preoperative diagnosis
and staging Numerator. Patients with nonsmall cell primary lung cancer undergoing thoracotomy
with complete surgical resection of tumor Denominator Patients with nonsmall cell primary lung
cancer undergoing thoracotomy 20. “Focus: Comprehensiveness of diagnostic workup Numerator:
Patients undergoing resection of primary cancer of the colon or rectum whose preoperative
evaluation by a managing physician included examination of the entire colon Denominator:
Patients undergoing resection for primary cancer of the colon or rectum.

41. Medication use indicators
• “Focus: Individualizing dosage Numerator lnpatients 65 years of age or older in whom creatinine clearance
has been estimated or measured Denominator Inpatients 65 years of age or older 27 “Focus liming of
medication administration - - Indicator Statement Patients with selected surgical procedures receiving
intravenous prophylactic antibiotics Timing of prophylactic antibiotic administration 28 “Focus Informing the
patient about the medication - Numerator lnpatients with a discharge diagnosis of insulin-dependent
diabetes mellitus who demonstrate self-blood-glucose monitoring and self-administration of insulin before
discharge or are referred for postdischarge follow-up for diabetes management Denominator: Inpatients
with a discharge diagnosis of insuIin-dependent diabetes 29 a “Focus Monitoring patient response
Numerator. Inpatients receiving digoxin who have no corresponding measure drug level or whose highest
measured level exceeds a specific limit Denominator Inpatients receiving digoxin’ 29b “Focus Monitoring
patient response Numerator lnpatients receiving theophylline who have no corresponding measured drug
level or whose highest measured level exceeds a specific limit Denominator Inpatients receiving theophyllin
29 c “Focus Monitoring patient response Numerator: Inpatients receiving phenytoin who have no
corresponding measured drug level or whose highest measured level exceeds a specific limit Denominator
lnpatient receiving phenytoin ” 29 d “Focus: Monitoring patient response Numerator: Inpatients receiving
lithium who have no corresponding measured drug level or whose highest measured level exceeds a specific
limit Denominator inpatient receiving lithium” 30 “Focus Reviewing complete drug regimen Indicator
Statement: Inpatients Number of prescribed medications at discharge”

42. Infection control indicators
• Focus: Surgical site infection Numerator: Selected inpatient and
outpatient surgical procedures complicated by a surgical site infection
Denominator: l’1umber of selected inpatient and outpatient surgical
procedures” 2. Focus: Ventilator pneumonia Numerator: Ventilated
inpatients who develop pneumonia Denominator: Inpatient ventilator
days 3. Focus: Concurrent surveillance of primary bloodstream
infection Numerator: Inpatients with a central or umbilical line who
develop primary bloodstream infection Denominator. Inpatient
central or umbilical line days

43. Acute Care Indicators
• Device-associated infections in the surgical intensive care unit • Device use
in the surgical intensive care unit (central lines, ventilators, indwelling
urinary catheters) • Surgical site infections • Prophylaxis [antibiotic] usage
for surgical procedures • Total inpatient mortality (10 DRGs and all other
DRGs) • Neonatal mortality (direct admissions and transfers) • Total
perioperative mortality (Within 48 hours of anesthesia, by ASA class) •
Management of pregnancy (cesarean sections and VBACs) • Unscheduled
readmissions (within 15 and 31 days for 6 DRGs) • Unscheduled admissions
following ambulatory procedure (inpatient and observation admissions) •
Unscheduled returns to an intensive care unit Unscheduled returns to the
operating room • Isolated CABG perioperative mortality (by ASA class,
observed and expected) • Physical restraint use (total events, patients with
multiple events, duration, reasons) • Documented falls (10 measures) •
Complications following sedation and analgesia (4 areas)

44. Acute care ambulatory indicators
• • Unscheduled returns to the emergency department for same or
related conçiition within the specified time frame (within 24 48
and/or 72 hours)
• Registered patients’ time in the ED
• ED x-ray discrepancies requiring a change in patient management
• Registered patients leaving the ED before completing treatment
Cancellation of ambulatory procedures on the day of the procedure

47. Patient satisfaction

50. What should be measured ?
• What are the customers’ expectations?
• What aspects of customer 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 customers’ expectations and/or current professional
standards?
• Which outcomes are most important to our customers?
• How can these be measured ?

54. The Top Five Recommendations for
Improving the Patient Experience of Care
• #1: Use Patient Satisfaction as a Balance Measure—Not a
Driver for Outcomes
• #2: Evaluate Entire Care Teams—Not Individual Providers
• #3: Use Healthcare Analytics to Understand and Act on Data
• #4: Leverage Innovative Technology
• #5: Improve Employee Engagement

76. Performance Indicators for nursing