Becker’s asked six health system strategic leaders which key performance indicator they pay closest attention to when assessing system performance.
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Editor’s note: Responses have been lightly edited for length and clarity.
Question: What metric or operational signal do you pay closest attention to when assessing system performance — and why?
Trevor Bennett, MSN, RN. Chief Administrative Officer for Providence Swedish First Hill and Cherry Hill in Seattle: While there are countless operational and financial metrics that matter in a large health system, the signal I watch most closely is the strength of our culture of safety. Specifically, the level of psychological safety our physicians, APCs, and caregivers feel when engaging with senior leadership. If people do not feel safe to speak honestly, raise concerns, or call out risks without fear of repercussion, no metric will ever tell the full story.
As the saying goes, “Culture eats strategy for breakfast, lunch, and dinner.” A team that feels psychologically safe will surface problems early, collaborate openly, and drive continuous improvement long before dashboards show distress. Conversely, when psychological safety erodes, performance may look stable on paper, while real issues remain unspoken and unresolved. That is why I am so focused on our culture before I respond or champion a KPI.
David Muns. Chief Operating Officer, Artesia General Hospital (Artesia, N.M.): While it seems simplistic, you can identify a number of problems by trending gross revenue and patient volume. If these two items are not fairly consistent, it prompts us to look at revenue cycle and department processes.
Christopher Kane. Chief Strategy Officer and Senior Vice President, Phoebe Putney Health System (Albany, Ga.): Market share is a key metric as it’s a composite of multiple dimensions: Access, patient preference, differentiation of our service lines, and competition. Timely outpatient market share data is particularly important in evaluating performance. The adage “the market always wins” is true, and market share is an indicator of market behavior.
Tyler Stapp. Chief Operating Officer, Pineville Community Health Center (Pineville, Ky.): As COO of a rural, independent hospital, one of the key operational metrics I monitor is care transition efficiency. This metric reflects system-level performance, assessing the quality of communication, coordination, and workflow across both clinical and ancillary departments. By analyzing transitions, I can identify gaps and implement targeted improvements in handoffs, staffing alignment, and process integration. Optimizing care transitions enhances patient safety, reduces preventable complications, improves the patient experience, and strengthens both operational and financial performance.
Ben Dreher. Vice President of Strategy, Alina Health (Minneapolis): I track two metrics to assess our health system’s performance and the progress of our strategic priorities: Net Patient Service Revenue per Adjusted Patient Day and Operating Expenses per Adjusted Patient Day. I track these metrics side-by-side as two separate line graphs on a monthly basis over a 12-month view and layer in historical years as well. This approach measures true performance of the care delivery operations and cuts out the noise of one-time benefits/expenses and out of period adjustments.
The views provide a direct comparison of the health system’s revenue and expense efficiency while displaying monthly and annual seasonal variances to allow for a quick diagnosis of why the system may be over- or under-performing to plan. While both metrics are broad, they help shine a light on whether our strategic growth and care model transformation pillars are meeting performance targets. If there is an anomaly within our NPSR per adjusted day, we can quickly look at root cause metrics such as volumes and service portfolio. If our expenses per adjusted day are off, we can focus root cause analysis around our expense structure and utilization metrics.
Howard Whitfield. Vice President Operations, Chief Operating Officer, UNC Health Wayne (Goldsboro, N.C.): We pay special attention to operating margin, outpatient surgeries, ED volume/throughput, patient experience, and our quality dashboard. We track outpatient surgeries as a gauge of outmigration, ED volume and throughput for efficiency and resource management, and patient experience/quality to make sure we are doing right by our patients.
Our goal is to be in the top two quartiles for Press Ganey patient experience (rate the hospital) and top quartile for quality metrics compared to like hospitals in the Vizient database. Our mission is to keep care local without sacrificing quality.
