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.
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.
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.
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.
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