Value Add

BI & KPI -Continuously Improving Hospital Performance

BI can provide simple, focussed and traceable information about your hospital's performance

Every hospital wants to improve performance. But the devil is in the details, and if you don't specify clearly what you want to improve and then measure performance, your dreams will never take wing. Business Intelligence or BI allows management to have a clear idea of what is happening in the hospital or in multiple group hospitals. It is the next generation of reporting, where data from different sources can be collected in a data warehouse, cleaned and then presented in logical and actionable manner.

There are over 30 BI products in the market today. Starting from some good open source offerings from Pentaho, Jaspersoft, Redhat and OpenBI to the familiar (if expensive) names such as Cognos, Business Objects and Hyperion.

BI can provide simple, focussed and traceable information about your hospital's performance. It takes data from your Hospital Information System and other databases used in the hospital, to monitor Key Performance Indicators (KPI) that you have defined. Typically, BI solutions use easy-to-read Dashboards, similar in approach to how you monitor the functioning of your car. You can set desired values and have the BI solution alert you when there is a significant deviation. You can predict load, performance and collections using statistical analysis. Starting from the simpler analytics, you can go all the way into some mighty complex computations to identify problem areas well before they blow up in your face.

However, there are many instances of people accurately monitor the wrong things. A good way to set your metrics is to see how hospitals are typically rated and measure yourself against these parameters. Hospital Ratings typically focus on KPIs for clinical excellence, operating efficiency and financial health. Examples of some KPIs evaluating the hospital's overall performance would include:

• Risk-adjusted mortality index. lRisk-adjusted complications index.
• Risk-adjusted patient safety index.
• Severity-adjusted average length of stay. lExpense per adjusted discharge, case mix- and wage-adjusted.
• Profitability (operating profit margin). l Cash to total debt ratio. lTangible assets (net plant, property, and equipment) per adjusted discharge.
• Growth in patient volume.

In addition to these, department-specific or function specific KPIs are to be decided on. As an organisation, you may end up monitoring between 30 and 50 KPIs. When done effectively, you allow managers at every level to monitor KPIs that their teams impact. KPI design should also include verifiers and complementary indicators to enable self-testing of the information that is projected through the dashboards. Examples of some lower level KPIs to monitor daily performance would include:

Emergency Room

• Door to Provider Time lAdmission to Provider Time lLength of Stay lWait Time for Ambulances lThroughput (Urgent/Non-Urgent) lTriage to Initial Assessment lBed Turnover
• Staff Applied To Each Type of Patient

Type of Cases

Operating Room

• Utilisation Rates l% of Post-Op infections
• Operation Notes - Detail level
• Wait time for specific OT/ equipment
• Revenue generation by OT

Inpatient Management

l% of Diagnosis present during Admission

• Bed days per diagnosis
• Nursing - Friendliness
• Nursing - Responsiveness
• Bed Occupancy Rateh
• Bed Turnover
• Revenue per Bed day by diagnosis
• Diet - Variety
• Diet - Taste

Customer Satisfaction

• Ease of obtaining Appointments
• Responsiveness of staff
• Wait Times
• Quality of Physician
• Cleanliness

Diagnostics

• Time to sample
• Time to receive results
• Reagents consumption by test
• Revenue per equipment
• Revenue by investment
• Equipment utilisation rate
• Accuracy of results
• Tests per Technician
• Revenue per Technician

After an effective BI implementation, typically Hospitals have seen improvements in:

• Adverse events and unplanned readmissions - 7% reduction
• Patient Satisfaction -15% improvement
• Staff Overtime - 11% decrease

Implementing a BI System is usually driven by top management, who immediately see its tremendous value, but most successful BI implementations have dashboards and reports for managers at all levels. Every employee who is responsible for the performance of a department or function will be benefited by a BI system. Sharing the benefits of the system offers dual benefits - obtains Buy-in from staff at multiple levels, and ensures that data accuracy is checked and ensured at various stages.

Again a BI implementation is not a 'Fit and Forget' operation. The initial process requires some serious management time and is likely to go through at least two reviews before some stability is seen. And you know that your BI is working only if you are adding and modifying KPIs at regular basis.

A BI implementation involves the selection of IT Tools, review and updation of sections of your HIS, Design and implementation of the solution and ongoing support to keep your performance indicators updated. It may be the most useful IT implementation you have ever done.

M Vennimalai, CEO, Aavanor Systems