How to Understand Key Performance Indicators in Health Care

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Key performance indicators (KPIs) in health care are part of the provider’s quality and risk management plans. Providers choose their KPIs as a result of several factors, including regulatory and accrediting body initiatives and recommendations, as well as identified organizational improvement areas. Both the Joint Commission and the Joint Commission International (JCI) publish national and international patient safety goals as well as core measure sets. Reviewing these will give you a clear picture of an organization’s key performance indicators.

Things You'll Need

  • List of national/international patient safety goals defined by the Joint Commission
  • List of Joint Commission core measure sets
  • Organization-specific quality information

Read the current national/international patient safety goals as determined by the Joint Commission and/or JCI. Updated yearly, all organizations follow and track internal information related to these goals.

Identify current core measures. Core measure sets are in addition to the patient safety goals. The Joint Commission/Core Measures Initiatives include: a. Acute Myocardial Infarction Core Measure Set b. Surgical Care Improvement Project Core Measure Set c. Heart Failure Core Measure Set d. Pneumonia Core Measure Set e. Perinatal Care Core Measure Set f. Pregnancy Core Measure Set g. Hospital Outpatient Department Quality Measures h. Children's Asthma Care i. Hospital-Based Inpatient Psychiatric Services j. Venous Thromboembolism (VTE) Core Measure Set k. Stroke (STK) Core Measure Set

Regardless of which measure sets an organization selects, each hospital/clinic must collect certain data elements. These data elements are considered “general” to each patient’s episode of care. The Specifications Manual for National Hospital Quality Measures details the required data elements.

Check individual health care websites. These sites list internal quality and performance improvement measures specific to their organization’s goals. Providers establish goals that measure what they want to improve. These can be clinical or non-clinical goals.

Compare key performance indicators chosen by individual health care providers to the required regulatory elements, including national patient safety goals and core measures to determine the areas each wishes to track as part of process and organizational improvement.

Assess whether defined non-clinical indicators (operational indicators) are critical to understanding and improving care and ensuring operational efficiency. To meet and exceed customer expectations, an understanding of ongoing performance monitoring and improvement in critical systems and processes is a necessity. Organizations monitoring multidimensional quality measures indicate awareness of the processes most important to the customer such as indicators on patient satisfaction.

Determine whether a provider's clinical and non-clinical KPIs adequately address recognized diseases most prevalent within the hospital/clinic, region or area associated with the provider’s patient base.

Evaluate the three main areas comprising KPIs for each organization to determine their effectiveness to the goals established for the organization. They include national patient safety goals, core measures, and internally defined clinical and non-clinical indicators related specifically to the organization's quality goals.

Tips & Warnings

  • One focus of Strategic Quality Initiatives is to document the outcomes of the care, treatment, and services provided and identify opportunities for improvement. Crucial to carrying out this initiative is the data analysis phase. The objective of data analysis is to compare individual performance to various reference points, identify undesirable trends, determine root causes of performance variances, identify action plans to address these variances and determine effectiveness of improvement efforts.
  • Aggregating and analyzing transforms data into information that can be used to plan, change or monitor care. Performance is compared against industry standards, internal benchmarks, comparable external organizations, and best practices to determine patterns and trends. Ask these questions to help understand designated KPIs:
  • What is the current level of performance?
  • What are the priorities for performance improvement?
  • For areas where variances are significant, what improvements are needed?
  • Were strategies employed to improve performance effective?

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