The metrics healthcare leaders check daily

Becker's asked healthcare leaders to share the metrics they check daily to track their organization's performance.

Here are their responses, presented alphabetically. 

Editor's Note: Responses have been lightly edited for length and clarity.

Sree Chaguturu, MD
Chief population health officer of Partners HealthCare (Boston)

In the context of population health management — where we are focused on improving patient outcomes and reducing overall healthcare costs — those changes happen over time. We check monthly metrics for our clinical programs and quarterly metrics for financial performance. It is equally important for me, however, to check on the overall health of our clinical transformation staff. "How are you doing? How are things going?" are some of the most important questions for me to ask my team on a daily basis.

Leigh Hamby, MD
CMO of Piedmont Healthcare (Atlanta)

In healthcare and at Piedmont, there is no more important item to measure daily than progress toward delivering high-quality, patient-centered care. We are several years into our 10-year goal toward Zero Harm — which means eliminating hospital-acquired Infections from our hospitals. We've found that the most effective way to eliminate HAIs is relentless adherence to standard work. We know what to do to prevent infections, so when we do that 100 percent of the time, we can make great progress in rooting out infections. In order to do this, our clinical staff is constantly monitoring compliance to specifically outlined standard work for the most common HAI — central line-associated bloodstream infection, catheter-associated urinary tract infection, methicillin-resistant Staphylococcus aureus, Clostridium difficile and surgical site infections. Accordingly, each of the system’s nine legacy hospitals (those that are on or have been converted to our electronic medical record system) are updated daily on a number of metrics, including the percent to which they are in compliance with our standard work regarding C. difficile, CAUTI, CLABSI, MRSA and SSI Colon, among others.

Steve Hess 
CIO of UCHealth (Aurora, Colo.) 

A lot of what comes out on a daily, weekly, monthly basis with metrics comes out of our core Epic IT system. We look at what the operational leaders in each of the hospitals and ambulatory areas need. The way I phrase it is, "What do you want to know before your first cup of coffee of the day?" in terms of what happened yesterday, what's about to happen today. So a lot of what we do is focusing on that top-down. What do the operational leaders want to see first thing to figure out where they need to focus? What we do is, we create capabilities to then have folks on their teams drill down and find answers to why metrics are what they are. 

We look at month-to-date type metrics — how many admissions were we expecting? What ambulatory visit volumes were we expecting? We work with our finance team for any given month, what do we expect our volumes to look like on day three, day 23? Then we compare the actuals against that, so even on the second day of the month we can start projecting out what the month is looking like, so adjustments can be made in areas where they can positively impact the rest of the month. So at any moment our system CEO, and all the hospital CEOs and presidents, can see where they are from a financial perspective, from a capacity perspective, from a patient care, length-of-stay perspective and then the same thing for the ambulatory.

We look at analytics and metrics as three different tiers: At the highest level, we have an automated system that pushes out an email with an attachment at 7 a.m. daily that talks about census — a census around what do our med-surg beds, ICU and OB beds look like [as far as capacity]. A COO or vice president of operations is going to want to drill into the metrics, so tier two is the ability to drill down into specific hospitals or specific ambulatory clinics or even specific providers. Tier three is the ability to see the precise records in Epic that fed to that tier two and tier one data. It's all the same source of truth. It's just different levels of detail you can get to.

Overall, the metrics really should be consistent and should be clearly defined across the enterprise. Making sure everybody is measuring length of stay the same way and everyone's measuring a discharge the same way and making sure that's approved by operational leadership is crucial. The more you can bring operational and clinical leaders into a metric build, the better you're going to be because then they trust the data and you're getting past the argument of, "the data must be wrong," and you're getting to the work it takes to actually make an impact on the organization.

Michael Hulefeld
Executive vice president and COO of Ochsner Health System (New Orleans)

Ochsner reviews and analyzes capacity, safety and patient experience metrics. For more than a year, we receive safety metrics via a daily huddle process which we think is incredibly important.

We constantly review daily metrics around capacity, such as hospital emergency department volumes; ED holds (patients who are waiting for a hospital bed); hospital census; patients who may have left the ED without being seen; and discharge volumes.  The large number of hospital-to-hospital acute patient transfers requires us to look at our daily transfers and mistransfers, which we view as a potential safety event if we're unable to accommodate a patient who needs high-end care. We examine these areas on a daily basis as an opportunity for process improvement and best practices.

With a large employed physician group of more than 1,300 doctors, we also look at daily clinic visits not only for volume, but also from a patient experience perspective. This includes reporting out daily on general patient communication with the expectation of achieving a 95 percent patient message response on the same day. 

These are just a few ways we continue to evolve and create a more patient-focused view.

Michael LeBeau, MD
President of Sanford Health (Bismarck, N.D.)

We must maintain a high level of safety and quality to be successful. In the medical center, we closely track hospital-acquired conditions and falls. In our clinics, we monitor preventive healthcare, such as hypertension, breast cancer screening rates and diabetes. All leaders see these numbers when they log into our intranet site. Additionally, we are always mindful of our patient experience scores.

Of course, we must perform financially, as well, to continue providing quality care. It's by no means an exact measure, but I can tell how busy we are on a daily basis simply by asking our valet parking attendants how many cars they parked the day before. More specifically, we look at length of stay, the number of emergency visits, clinics visits, deliveries and procedural volumes. To track expenses, we have productivity targets for staffing. Monthly, we measure medical center cost per case mix index adjusted admission and clinic overhead per work relative value unit.

Greg Madsen
Vice president of Carilion Stonewall Jackson Hospital and Northern Region operations (Lexington,Va.) 

I track hundreds of data points on a weekly basis for Carilion Stonewall Jackson Hospital, which includes financial performance, payor mix, quality indicators, market share trends, expense variances, patient experience and many more.  Within this universe of data, I place the highest importance on employee engagement data.  For me, it’s the No. 1 thing we measure.  Without an engaged workforce, it is impossible to expect excellence within the other metrics.  Our team is literally the foundation of everything we do at this (and I would suggest every other) hospital.  I firmly believe that if we support our team, and ensure they are properly resourced, informed and engaged, that they will provide excellent care to our patients and as importantly to each other. Within the employee engagement scores, I pay special attention to questions that relate to employees having a voice, trusting in their leadership and understanding the strategic direction of the organization. In my 30 years working in hospitals, it has become more challenging, increasingly fast-paced and substantially more resource-limited. However, one thing that has remained constant is that a high performing workforce is the most effective tool for sustainable success.

Rene Olson
Senior adviser to Intermountain Healthcare's COO (Salt Lake City)

Intermountain facilities and services hold 1,500 daily huddles that roll up to a single daily 10 a.m. system huddle that reviews metrics for the entire organization (23 hospitals, 170 clinics, medical group, home care, other medical services, and SelectHealth, Intermountain's insurance company). 

Daily metrics tracked include safety (potential serious safety events, caregiver injuries), quality (readmissions within 72 hours), access (units at capacity, diverts and transfers), stewardship (downtimes), and examples of extraordinary acts of service and compassion performed by engaged caregivers. These huddles provide real-time data that allow the organization to act quickly and in a coordinated manner to address issues.




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