Part 1 of this series explained the three dimensions of hospital performance, and Part 2 explained that the dimensions are related, that adjusting performance in one dimension, will have flow-on consequences for the other two.

This post talks about the key performance indicators (KPIs) that can be used to measure the performance of each of the three dimensions. The KPIs are illustrated here:

The data in a Hospital Information System (HIS) plays a central role in generating the KPIs for these three dimensions. A hospital will have other systems, most notably Finance and HR, which also contain valuable KPI data. However, a HIS is uniquely positioned to allow management to balance the three interrelated dimensions because the HIS is the only one that works at the patient-level. Data is not aggregated at the service, department or hospital level. This granularity allows management to create actionable KPIs.

The following KPIs are provided as examples only. Every management team will need to decide on their own KPIs and provide unambigous definitions for each of them, definitions which makes sense their staff.

It should also be noted that some KPIs can fit into multiple categories. For example, the 'Readmission Rate' can either be a measure of the quality of care (re-admissions should be close to zero), or it could be a measure of access since the expected readmission rate should be taken into account when deciding how many new admissions should be accepted.

##Quality Dimension

**Safety, Performance and Quality** KPI examples:

- Infection Rates
- Readmission Rate
- Patient-to-Staff Ratio
- Mortality Rate
- Preventable Errors/Incidents
- Adherence to Treatment Plans/Protocols
- Unplanned Transfers to Critical Unit or Surgery
- Time to Complete Medical Record
- Time to Complete Discharge Summary

**Patient Engagement** KPI examples:

- Patient Satisfaction
- Discharges Against Medical Advice
- Patient Information Packs Distributed
- Patient Complaints/Compliments
- Privacy Breaches
- Patient Follow-Ups

##Access Dimension

**Patient Access And Flow** KPI examples:

- Bed Turnaround Time ()
- Average Length of Stay
- Patient Wait Time (Inpatient, Outpatient, ED)
- Cancelled/Rescheduled/Missed Appointments
- Admission Rate
- Discharge Planning Time
- Patient Transport Delays
- Operating Theatre Turnaround Time
- Care Coordination
- Lab Test Wait Time
- Internal/Referral Wait Time
- ED Admission to Discharge Time
- Inbound Referrals (Referred/Accepted)
- Outbound Referrals/Transfers
- Operating Theatre Cases (Booked/Performed/Rescheduled/Delayed/Cancelled)

**Facility and Equipment** KPI examples:

- Equipment Utilisation Rate
- Bed Utilisation Rate
- Room Utilisation Rate (Inpatient, Speciality Wards, Operating Theatre, Outpatient)
- Telehealth Utilisation
- Total Diagnostic Tests Performed (Pathology/Radiology)
- Total Prescriptions Dispensed

These **Staff** KPIs relate specifically to a HIS. Additional KPIs can be pulled from the HR System. KPIs from a HIS relate to the utilisation/mix of staff used for direct patient care. That's information that does not exist in the HR System. All things being equal, you want to match staff qualifications, experience and skills to the clinical task being performed (e.g. the chief surgeon does not need to do all bedside consults, an junior nurse can take and record observations). Examples:

- Surgical Consultations Performed By
- Medical Consultations Performed By
- Nursing Consultations Performed By
- Pharmacy Consultations Performed By
- Allied Health Consultations Performed By
- Surgical Attendance (Surgeon, Assistants, Anaesthetists)

##Price Dimension

The **Charge Capture** KPIs relate to making sure that all services performed can be attributed to the patient that received those services. For example, if a pathology test is not correctly attributed to the patient, that pathology test will not be invoiced and the hospital has effectively performed the service for free. Examples:

- Percentage of Diagnostic Tests Invoiced
- Percentage of Consultations Invoiced
- Percentage of Medications Invoiced
- Difference Between Estimated and Actual Costs (if patients get treatment estimates)
- Invoice Generation Time

The **Claiming** KPIs relate to how well the hospital claims benefits from the government or the patient's insurer. Invoicing and claiming could be done from a separate finance or claiming system (assuming that hospitals decide to claim on patient's behalf rather than invoicing the full amount and asking patients to seem reimbursements). But if claiming is done from the HIS then the following KPIs should be considered:

- Claim Submission Time
- Claims Denied or Reduced
- Deposits Taken on Admission
- Payments Made At Discharge

Other posts in this series:
- Part 1: The Three Dimensions of Performance
- Part 2: Relationship Between the Three Dimensions