Performance Indicators

for
Hospitals

- Niladri Majumder
 Roadmap

 Operational Excellence – Demand of the Hour

 Importance of Indicators in Hospitals
 Types of Hospital Performance indicators
 Discussions on Key Indicators

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Challenges to Healthcare
Providers
■ Improving patient safety
■ Improving clinical outcomes through error reduction and
process automation
■ Improving communications & trust between physicians and
hospitals
■ Reduction in cost of healthcare
■ Making hospitals more operationally efficient
■ Strategies for curbing Healthcare Associated Infections
■ Incorporating technology into medicine

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Shrinking Margins : Hospital
Expenses vs. Revenues

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Hospitals have to be operationally
efficient to ensure their
sustainability in the long run.
Performance Indicators helps
quantify performance which
facilitates process improvement
initiatives systematically
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Operational Excellence
results from Better Quality

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Why INDICATORS ???

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What is Indicator?
 An indicator or measure refers to numerical information
that quantifies input, output, dimensions of processes and
outcomes.

 The measurement relates to performance but is not an

exclusive measure of such performance (e.g., the number
of complaints is an indicator of dissatisfaction, but not an
exclusive indicator of it)

 The measurement is a predictor or “leading indicator” of

more significant performance (e.g., a gain in patient
satisfaction might be a leading indicator in HMO retention

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IndicatorsCare Provider
Organization (CPO)
Performance

Patient
Clinical Outcomes
Satisfaction

Business
Performance

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Patient Satisfaction Indicators

Accessibility of
the Hospital
Behavior &
Services Availability &
Promptness
Waiting Time
of Hospital Staff
PATIENT
SATISFACTION
INDEX
Doctor Patient
Hygiene & Cleanliness
Communication

Facilities, Amenities &

Infrastructure

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Patient Satisfaction Indicators
 Apart from the Patient Satisfaction Index there are
multiple indicators which reflect patient satisfaction in a
hospital:

 Repeat Visits in OP / Ambulatory Care

 Elective Surgery Cancellations

 Leave Against Medical Advice (LAMA)

 Inward Referrals

 OP / IP Conversion Rates

 Emergency / IP Conversion Rates

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Clinical Outcomes Indicators
 Hospital Acquired Infection

 Urinary Tract Infection ( UTI)

 Blood Stream Infection (BSI)

 Respiratory Tract Infection ( RTI)

 Surgical Site Infection ( SSI)

 Quality of Nursing Care

 Patient Falls

 Bed Sores

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 Clinical Outcomes Indicators
 Average Length of Stay

 Bed Turnover Rate

 Unplanned Returns to OR within 24hrs

 Cancelled / Postponed Surgeries

 Wrong Site / Wrong Patient / Wrong Procedure Surgery Incident Reporting

 Gross / Net / Anesthesia Death Rate

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Business Performance
Indicators
 Bed Occupancy Rate

 EBITA ( Earnings before Tax, Interest,

Depreciation and Amortization)

 Net Operating Margin

 Daily Collections – IP, OP, Lab & Radiology, OT,

ICU

 Clinical Specialty wise Earnings

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Important Indicators for Detailed
Discussion
 Inpatient Bed Count

 Average Length of Stay

 Bed Count Days

 Bed Occupancy Rate

 Bed Turnover Rate

 Bed Turnover Interval

 Death Rate

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Inpatient Bed Count

 The number of available facility inpatient beds, both occupied

and vacant, on any given day
 In a hospital this includes beds set up for normal use, whether

or not they are occupied

 May be reported for the entire hospital or for any of its units

 In a hospital, the number of available beds in a facility or a unit

may remain constant for long periods of time

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Inpatient Bed Count
 Other names
 Bed complement

 Bed capacity

 This may be confusing as this also denotes the number of

beds that a facility has been designed and constructed to

contain

 The number can and often does change

 Some beds may be unavailable during a major remodeling or

renovation project
 May increase after the project is completed

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Inpatient Bed Count
 Excludes beds in

 Treatment rooms
 Examining rooms
 Emergency services
 Physical therapy
 Labor rooms
 Recovery rooms
 Newborn beds, called bassinets, are computed
separately from the bed count

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Newborn Bassinet Count

 The number of available hospital newborn

bassinets, both occupied and vacant, on
any given day

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Average Length of Stay
 The total number of patient days for an inpatient
episode. The duration of an inpatient's hospitalization is
considered to be one day if he is admitted and discharged
on the same day and also if he is admitted on one day and
discharged the next day. The day of admission should be
counted but not the day of discharge.

Total No of Inpatient Bed days for Discharged patients

___________________________________________________

Total No of Discharges and Deaths

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 Bed Count Days
 A unit of measure denoting the presence of one inpatient bed (either
occupied or vacant) set up and staffed for use in one 24-hour period

 Refers to the sum of inpatient bed count days for each of the days in
the period under consideration
 May be referred to as the maximum number of patient days or
potential days because they represent a statistical probability of
every bed being occupied every day

If every hospital bed were filled each day the occupancy

rate would be 100 percent

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Bed Occupancy Rate
 The ratio of inpatient service days to bed count days in the period under consideration

 The inpatient census represents the actual occupancy (number of occurrences)

 The bed count represents the possibility for occupancy (number of times it could have occurred or the maximum possible)

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 Bed Occupancy Rate ( BOR)
•The Bed Occupancy Rate is always expressed as a percentage.

•The BOR is calculated for a specific time period ( week, month or year ). It can be
calculated either for the entire hospital or ward / specialty specific

Total Inpatient Admissions x Average Length of Stay

___________________________________________________
X 100
Total Inpatient Beds x Total No of Days

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Bed Occupancy Rate ( BOR)
• The BOR of an acute care hospital should not
exceed 80%. The rationale is that no deserving patient
should be refused admission at any point of time. The buffer
allows scope for emergent admissions and absorbs time loss
between discharge and bed preparation for the next patient

• The BOR of Intensive Care Settings such as ICU,

NICU, PICU, Burn Unit should not exceed 75%.
This implies that some beds should always be unoccupied. This
ensured greater probability to admit deserving patients at any
point of time.

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Bed Turnover Rate
 The number of times a bed, on average, changes occupants
during a given period of time, OR

 The average number of admissions per bed per time period

 Useful because two time periods may have the same percentage
of occupancy, but the turnover rates may be different

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 Bed Turnover Interval
Average period in days that an available bed remains empty
between the discharge of one inpatient and the admission of
the next.

•Indicates the time that available beds are free.

•Indicates a shortage of beds when negative, and under-
use of the hospital or an inefficient admission system, if positive.

Available beds x days in the period ‑ patient days for the period
Number of discharges, including deaths, in the period

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Hospital Death Rate
Note: Patients who are dead on arrival (DOA)
at a hospital are not included when
calculating these rates.
A ratio of all inpatient deaths for a given period to the total
number of discharges and deaths in the same period.

Total number of deaths of inpatients in a given period x 100

Total number of discharges and deaths in the same period

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Net Death Rate & Post
Operative Death Rate
 NET DEATH RATE - A death rate, also known as the institutional death
rate, that does not include deaths, which occur within 48 hours of
admission (24 hours of admission in some countries).

Previously, it was that those deaths that occur within 48 hours of admission
should not be counted because not enough time had lapsed to allow the
health care providers adequate time to directly affect the patient’s condition.
However, with today’s technology, this concept is no longer thought to be
valid. Therefore, it is recommended that net death rates not be calculated
unless there is a special order to do so.

 POST OPERATIVE DEATH RATE - The ratio of deaths within 10 days

after surgery to the total number of patients operated on during that
period.

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Common Indicators in E.M.R

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Hospital Performance
Dashboard

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Indicators in E.M.R

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THANK YOU

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