Ask COOs and other strategic leaders which operational metric matters most right now, and the answers span a wide range: length of stay, patient throughput, transfer acceptance rates, facility utilization, workforce retention, access. But a common thread runs underneath: With physician shortages tightening access and margins under sustained pressure, leaders can no longer simply add capacity to fix a problem. That has pushed many health systems to get more disciplined about the capacity, space and people they already have, and to treat their chosen metric less as a standalone number to hit and more as a proxy for how well the whole organization is running.
Becker’s asked COOs and other strategic leaders at hospitals, health systems and other organizations: Which operational metric is of renewed importance for your health system?
Note: Answers have been lightly edited for length and clarity.
Darryl Elmouchi, MD. COO of Providence (Renton, Wash.): Without a doubt, it is length of stay (LOS). However, we view this metric in a different light than the historic norm. LOS, when approached holistically and with the balanced metric of 30-day readmissions, is a surrogate for hundreds of processes throughout a hospital and ambulatory network. When they all work in concert to shorten LOS, all other important metrics — quality, safety, patient experience and caregiver experience — follow suit. That’s why we view LOS less as a hospital throughput metric and more as a marker of a well-oiled machine that improves many other important outcomes.
Carol Gomes. CEO and COO of Stony Brook University Hospital (Stony Brook, N.Y.): Patient flow and throughput have taken on renewed importance as they touch nearly every aspect of hospital performance. Effective patient flow helps create capacity to care for more patients, improves the patient experience and allows us to use our people and resources more efficiently. It is also closely connected to quality, safety, and financial performance, making it an important indicator of how well the organization is functioning overall.
Eric Stevens. COO of Adventist Health (Roseville, Calif.): Healthcare uses many metrics to measure performance against targets. Then there are super metrics: those that measure a complex set of actions and, perhaps, management’s resolve to fulfill a stated mission.
For me, the super metric I focus on most is access. The promise of high-quality care, delivered by people ethically and emotionally prepared to see those they care for as whole people, worthy of their best work, is theoretical unless people can actually access it. Creating access is a paramount and ongoing consideration for any organization in the business of caring for people.
Patrick Tuer. Executive Vice President and COO for Encompass Health (Birmingham, Ala.): One operational metric that has taken on renewed importance for our company is workforce retention, particularly among clinical team members. While turnover has always been an important measure, we increasingly view it as a leading indicator of both organizational health and patient outcomes.
At Encompass Health, we’ve made a deliberate investment in developing and implementing clinical career ladders that create meaningful opportunities for professional growth and advancement. These programs help our clinicians envision a long-term future with the organization, strengthen engagement and provide clear pathways to develop new skills and leadership capabilities.
Retaining experienced clinicians benefits far more than workforce stability. When patients are cared for by tenured, highly engaged teams, they experience greater continuity of care, stronger collaboration among caregivers and, ultimately, better clinical outcomes. Experienced team members also serve as mentors for newer clinicians, helping to reinforce best practices and maintain the high standards of care our patients expect.
For us, workforce retention is not simply an HR metric; it’s a patient care metric. By investing in our people and creating opportunities for growth, we’re building stronger teams, enhancing the patient experience and supporting the consistently high-quality outcomes that are central to our values.
Joel Fagerstrom. Executive Vice President and COO of St. Luke’s Hospital & Health Network (Bethlehem, Pa.): One operational metric of renewed importance for St. Luke’s University Health Network is access capacity utilization—specifically, how effectively we convert available clinical, procedural, and diagnostic capacity into timely patient access. The reason this metric has become increasingly important is that healthcare demand continues to outpace workforce growth. The challenge is no longer simply adding beds, providers, or staff; it is maximizing the productivity and throughput of the resources we already have.
Across St. Luke’s, we are placing greater emphasis on metrics such as appointment availability, operating room utilization, schedule fill rates, no-show rates, and throughput because they directly influence patient access, growth, financial performance, and workforce sustainability. What makes this metric especially relevant today is the convergence of labor constraints, rising demand, and new technology capabilities. St. Luke’s is increasingly using analytics and AI-enabled tools to identify unused capacity, reduce scheduling friction, improve throughput, and ensure patients receive care sooner. For example, internal analyses have demonstrated meaningful value from initiatives that improve operating room block utilization, reduce appointment no-shows, and increase workforce productivity without increasing staffing levels.
These efforts reinforce that access is not merely a patient experience measure, it is one of the clearest indicators of how effectively a health system converts resources into care delivery and organizational value. Ultimately, I believe the leading health systems of the next decade will distinguish themselves not by the resources they possess, but by how efficiently and intelligently they deploy those resources to improve access, quality, and outcomes.
Kathy Donovan. Senior Vice President and COO of Hospital Sisters Health System (Springfield, Ill.): Transfer center acceptance rate is a critical enterprise operational metric because it reflects how effectively a health system translates clinical capability and capacity into patient access. For Hospital Sisters Health System, this is particularly important given the many rural communities we serve, where patients often depend on an efficient transfer process to receive timely higher-acuity services.
We have spent the past 18 months centralizing and enhancing our Illinois patient transfer center, aiming to improve patient flow efficiency, reduce wait times, and optimize resource utilization. In the first year of the initiative, acceptances increased by 17.4%, and we are now focused on hardwiring and sustaining these practices. These efforts demonstrate the value of using transfer center performance as part of a coordinated approach to improving access and operational efficiency. When evaluated alongside transfer demand, denial reasons, and broader throughput metrics, acceptance rate helps healthcare leaders identify areas of constraint and support informed operational decisions.
Jon Reuter. Chief of Operations for Keck Hospital, Keck Medicine of USC (Los Angeles): Inherent in our Keck Operating System is a balanced scorecard that ensures every manager’s level and above are measured equally on quality, safety, people, service, access, growth and financial stewardship. Our patients are at the center of our planning and priorities and this framework ensures appropriate alignment and accountabilities for our clinical and nonclinical teams.
Joshua Michalski. COO of Kettering (Ohio) Health: The operational metric I would highlight is emergency department throughput, particularly door-to-discharge time. We have broken the patient journey into its smallest components to understand how incremental improvements can add up, it is truly a game of minutes and seconds.
Sustained success, however, depends on more than lean processes. It requires highly integrated, cross-functional teams that continually coordinate and adapt the work around each patient’s unique needs. Improving throughput allows hospitals to serve more patients, but the greater purpose is providing faster access to care, improving clinical outcomes, and creating a better patient experience. It is difficult work, but it is worth doing — and continually improving
Lyndon Edwards. COO of Loma Linda (Calif.) University Health Hospitals: While we rely on a broad set of metrics to evaluate organizational performance, patient throughput remains among the most critical. It reflects performance across the care continuum, including emergency department flow, average length of stay, operating room efficiency, and ambulatory access measures such as the third next available appointment. Maintaining strong throughput helps reduce delays, optimize resources, and ensure patients receive the right care at the right time and in the right setting.
Cindy Russo. COO of Knox Community Hospital (Mount Vernon, Ohio): Patient access is a critical metric to monitor as it is a leading indicator of both operational performance and patient experience.
Time to the third next available appointment or 3NA is a common way to measure access which allows for benchmarking your performance against others.
In today’s environment — where patients expect convenience, competition is high, and primary care access drives downstream revenue — this metric has become a strategic lever, not just an operational one. Long waits drive frustration, leakage and delays in care.
Better access improves throughput, reduces no-shows and supports provider productivity — all of which contribute to margin and mission.
Monitoring this metric is essential and deploying initiatives to improve it are critical to organizational success.
Brian Evans. COO of Optim Health System (Savannah, Ga.): Operating expense as a percentage of net revenue. Expenses continue to be a challenge with inflation, key shortages and labor cost driving up the number. Meanwhile, reimbursement, bad debt, and payer mix shifts are eroding net revenue. We want to measure how well we are balancing expenses versus net revenue.
Kurt MacDonald. Vice President of Operations for University of Michigan Health-West (Wyoming, Mich.): As financial pressures continue to challenge healthcare organizations and workforce models evolve, we have placed renewed focus on how effectively we utilize our physical assets. One metric that has become increasingly important is the percentage of our facility footprint dedicated to direct patient care and other revenue-generating activities.
By evaluating how space is used across our campuses, we can identify opportunities to repurpose underutilized areas for clinical services that improve access while maximizing the value of existing facilities. At the same time, we must strike the right balance between operational efficiency and the experience we provide for both patients and team members.
This work requires looking at our facilities with fresh eyes and challenging long-standing assumptions about how space is allocated. In many cases, optimizing existing footprints can create meaningful capacity and access improvements without the need for major capital investments. For us, facility utilization has become a key operational metric because it helps align financial stewardship, patient access and long-term growth.
Robert Wiehe. Senior Vice President and COO for UC Health (Cincinnati): Access. With physician and specialist shortages now a real constraint across most markets, you can’t just hire your way out of an access problem anymore, you must get more disciplined about the capacity you already have. That means template optimization, closing the gap between scheduled and actual utilization, cutting no-show and cancellation leakage, and making sure referrals convert instead of drifting to a competitor. Systems that run this well are effectively creating capacity out of thin air, and in a market where you can’t simply add more physicians, that operational discipline is becoming a real driver of market share, growth and improved patient experience.
Jatin Motiwal. Senior Vice President of WellSpan Health, Central Region (York, Pa.): Access is the metric I think about most because it touches nearly every aspect of the patient experience. Patients want high-quality care close to home, and our responsibility is to make sure we have the people, space and resources in place to meet that need. The WellSpan York Hospital expansion has reinforced how important access is and how much broader the definition has become. Access isn’t just about getting an appointment. It’s also about having the capacity to care for patients when they need advanced surgery, critical care or other specialized services, without having to leave the region.
A lot of our planning for the expansion has centered on that question: ‘How do we create the capacity and care environment needed for the future while making the experience even better for patients and care teams today?’ When we get access right, patients spend less time waiting and get they advanced care they need close to home, which ultimately leads to better outcomes. WellSpan York Hospital is there for the community in times of crisis. So much so that recent reports from McKinsey cite the hospital with being one of the busiest emergency departments in the nation, right here in Central Pennsylvania. Expanding our access across the hospital helps patients for generations to come as they seek care in times of need.
Bonnie Thompson. COO of Forest Family Dentistry (Austin, Texas): For us, it’s keeping payroll creep in check against the rising cost of doing business and evaluating our tech stack to ensure we are investing in the right tools. Every layer needs to be evaluated for efficiency and outcomes, otherwise it becomes just another added cost.
