In our Business Intelligence (BI) strategy consulting with healthcare clients, we are often asked how to design a metrics program so the data that ultimately populates the dashboards and drill-downs is inherently actionable. They ask: How do we design the BI data collection and presentation systems to focus our corrective actions and other interventions most effectively?
In our experience, metrics facilitate action when they exhibit four key characteristics:
- A clear definition – the meaning of the metric must be clear and unambiguous. In a surgical services context, the definition of a late start for a scheduled procedure must be precise, and agreed upon by everyone concerned. If three minutes past scheduled start is defined as late, there should be no haggling that four minutes is close enough to be considered on-time. When late surgical starts are aggregated up to a service line or an entire system, especially when used comparatively, the metric must represent a homogeneous population with regard to the definition of the metric.
- Clear attribution & dimensional focus – the attributes that describe or annotate the specific metric must be clearly defined, and must allow for focused response along some dimension that makes sense to the business operation. Most often these will align with one or more of the following:
- Organizationally-focused – staff and other aggregated resources (e.g. departments, service lines, programs, care setting) are organized and accountable in alignment with the mission of the enterprise or segment thereof. It is clear where the action is required in the organization in order to achieve the desired effect or outcome being measured.
- Process-focused – specific processes or standard operating procedures (e.g. standard orders or order sets, care plans, clinical pathways, standard or research protocols) are implemented and tracked for performance and compliance. It is clear in which specific process or activities action is required, in order to achieve the desired effect or outcome being measured.
- Specific Resource-focused – specific resources (e.g. individual staff or teams, facilities, materials, equipment) are monitored for performance and compliance with standards for quality, operations or regulations. It is clear with which types or instances of these specific resources action is required, in order to achieve the desired effect or outcome being measured.
Other Primary Entity-focused – specific critical entities that exist in the operational context being measured, each described by a potentially diverse set of differentiating attributes. For example, in a clinical context, patients are critical entities. The set of clinical, demographic, diagnostic, prognostic, treatment, outcome or other differentiating characteristics on patients is routinely examined and analyzed for potential patterns, and possible interventions.
- Timeliness – the metric must be captured and available to responders in sufficient time to allow an appropriate response. Metrics can evolve from being primarily retrospective, to real-time reporting, to predictive, each of which enables and facilitates a different type of action. At a minimum, they must be reported in sufficient time for a meaningful response to occur.
- Accountability – with any of the above, someone in the organization must be responsible and accountable for appropriate action and assessment. The responsible party(ies) must be ready to analyze the situation and deploy the appropriate resources, to take specific needed actions in response to the position or value of each metric relative to relevant performance standards or expectations.
Other factors such as high confidence in data quality and its source, effective communications to responders, and authority to act are also critical elements. Metrics programs and BI systems with these characteristics have taken a good first step toward enabling the focus and the improvements for which they are ultimately designed.