Straight Talk - "Key Performance Indicators"

August 15, 2013

Dear Friends and Colleagues,

The Greek philosopher Pythagoras once said, “Numbers rule the universe.” And was he ever prescient when it comes to 21st century healthcare, where metrics are growing in importance as we migrate from an analog (handwritten) to a digital (computerized) medical records platform. That gives us the tools to convert data to information and eventually to knowledge, enabling us to continually improve the care we deliver.

The questions are: How can we best measure healthcare? And what metrics can we employ? The answers to these questions are critical for all of us: for patients who desire the best care; physicians and healthcare systems who want to transparently provide this care; and payers who aspire to obtain value, defined as quality/cost.

One method of measurement is through what are called Key Performance Indicators (KPIs). When KPIs are graphically presented for immediate action, then meaningful and sustained improvement is possible. One example is our Intensive Care Units (ICUs), where a large sign visible to one and all reveals how many months we have gone without a central line infection. Currently we are at 44 months in our ICUs and have had an 82% reduction in central line infections throughout our entire hospital’s 715 beds since 2011. Prevention of central line infection is one meaningful KPI.

I would note parenthetically that a physician expert on quality recently visited NCH and discussed our use of such measures with Critical Care specialist Dr. Doug Harrington, ICU Clinical Coordinator RN Noele Walker, and RN Judy Villani, whom I worked with when I was still in practice between 1977 and 2000. This outside physician expert was mightily impressed with how well everyone knew our numbers—not only with central line infection prevention but also with other significant metrics, such as early recognition of sepsis (life threatening blood infections) and urinary tract infection prevention.

NCH is not alone in its quest for better analytical measurement. Many organizations have started reviewing, ranking, and trying to educate themselves and the public about metrics measuring clinical performance, quality, process, outcomes, safety, efficiency, patient satisfaction, and other KPIs.

Nationally, with nearly 6,000 hospitals, slightly over 6,000 physicians and countless other healthcare entities, comparisons remain elusive. But many agencies are trying, among them, Medicare, Joint Commission, National Committee for Quality Assurance, National Quality Forum, Society for Thoracic Surgery, U. S. News & World Report, Becker’s, Leapfrog, Most Wired, and the latest healthcare quality arbiter, Consumer Reports.

The bottom line is that today in healthcare, any one institution can be examined in multiple ways with different definitions of metrics, producing widely variable results. One challenge for all healthcare professionals interested in better outcomes is to agree on common metrics that are reliable, valid, and based on scientific evidence.

At NCH, we fully support transparency efforts, and have been part of the team that helped escalate our state from the 44th to the 34th in national ranking for healthcare quality. Last month, in recognition of this improvement, Florida won the prestigious Dick Davidson Quality Milestone Award (from the American Hospital Association. (

Determining standardized health quality metrics, like healthcare quality itself, is a constant journey. NCH intends to continue to be a leader in this march toward better metrics, to help our neighbors live longer, happier, and healthier lives.


Allen S. Weiss, M.D., President and CEO

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