System Metrics

A Toolkit for Redesign in Health Care: Final Report

During the implementation phase of process redesign, those involved will want to know whether the process changes have improved the health care system. One can develop these system metrics from the initial perspectives that were chosen at the beginning of the process. As noted above, for Denver Health these were efficiency, patient safety, quality, customer service, workforce development, and/or architecture/environment.

Defining the system measures before the project is started permits one to assess in advance if the measurement truly reflects the desire outcomes and determine if the data are available to create the measure. It is important to have the ability to acquire baseline (pre-project) data to measure the effectiveness of the change or intervention. It is important to develop a set of metrics for evaluating the impact of the many process improvements that will be implemented throughout the hospital system. In order for there to be replication of redesign efforts in other hospital systems, there needs to be an incentive for hospitals to invest in this effort. Both system-wide metrics and individual process improvement metrics need to be developed.

Some common system metrics that can be considered are described in the following table. This table describes a variety of financial, operational, clinical, and employee variables and maps them to each of the six perspectives. For example, cost per discharge is listed as a variable and it maps to efficiency. Many variables represent more than one perspective, emphasizing the need to consider all six perspectives with system-wide transformation.Many of these system metrics are commonly reported by hospitals for ongoing operations and management, such as average length of stay (ALOS) and cost per discharge. Other metrics may require primary data collection, such as total travel distance and discharge process time.

Given that there will be many concurrent rapid-cycle projects and system-wide projects, it may not be possible to identify which projects, singly or in combination were responsible for the change in a specific metric or metrics. In order to transform the system, it is not feasible to conduct one project at a time. However, each individual rapid cycle and system project should have specific metrics that address system-wide goals and perspectives.

Table of System Metrics

MeasureEfficiencyPatient SafetyQualityCustomer ServiceWorkforce DevelopmentArchitecture/ Environment
JCAHO Core Measures1 

X

X

   
Cost per Discharge2

X

     
FTE per Adj Occupied Bed

X

     
ALOS (Total)2

X

 

X

   
ALOS for Top 10 Diagnoses

X

 

X

   
Mean Wait Time in ED for Hospital Bed

X

X

X

X

  
Physician Productivity (Relative Value Units)

X

     
Net Revenue

X

     
Medication Errors3 

X

    
Errors Related to Procedure/Treatment or Test3 

X

    
Number of Cardiac Arrests (cor-0) 

X

X

   
Re-Admission Rates

X

X

X

   
Total Travel Distance

X

  

X

X

X

Patient Complaint Rate   

X

 

X

Patient Satisfaction4   

X

 

X

Discharge Process Time

X

  

X

  
Risk Adjusted Mortality 

X

X

X

  
Nurse Turnover Rate

X

   

X

X

Nurse Vacancy Rate

X

   

X

 
Employee Turnover Rate

X

   

X

X

Employee Vacancy Rates

X

   

X

 
Employee Satisfaction    

X

X

1 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Core Measures were designed to permit more rigorous comparisons using standardized, evidenced based measures in the areas of acute myocardial infarction), heart failure, pneumonia, pregnancy and related conditions, and surgical infection prevention. A description of these measures can be found on http://www.jcaho.org/pms/core+measures/core+measures.htm.
2Metric can be compared pre- and post-implementation of process improvements and to University HealthSystem Consortium (UHC) benchmark. UHC, formed in 1984, is an alliance of academic health centers situated mainly in the United States. As a membership organization, UHC provides its 90 full members and 123 associate members with a variety of helpful resources aimed at improving performance levels in clinical, operational, and financial areas.
3 The UHC Patient Safety Net is a data collection and reporting tool that allows member hospitals to identify and report patient safety issues. Through this system, Denver Health reports patient safety events and therefore will be able to identify improvements in patient safety.
4 Press Ganey administers patient satisfaction surveys to almost 900 hospitals throughout the country. On a weekly basis the hospitals send Press Ganey a list of inpatients for which Press Ganey selects a random sample to survey. Press Ganey calculates the percentiles and scores for these hospitals, including trends, and distributes results on an annual basis. Denver Health has been using this survey since 2001. More information can be obtained at http://www.pressganey.com/

Current as of September 2005
Internet Citation: System Metrics: A Toolkit for Redesign in Health Care: Final Report. September 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/toolkit/toolkit6.html