Skip to main content

Measuring Performance in Hospitals: The Development of an Operational Dashboard to Coordinate and Optimize Patient, Material and Information Flows

  • Chapter
  • First Online:
Boundaryless Hospital

Abstract

Currently, many Western countries are seeking ways to increase the efficiency and quality of health care. These efforts reflect stakeholders’ expectations of improving performance in response to two important challenges. First, health care expenditures rise continuously and question the financial sustainability of current delivery systems. Secondly, health care systems suffer from unexplained variability and gaps in the quality of the patient-centered care. To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. This assumes an integrated view on patient, material and information flows to align the different steps in the care process with the supporting processes and the required resources. Consequently, the development of process-oriented performance measurement systems is crucial. Most performance measures in hospitals are not process-oriented at the moment and cannot help a health care system to better synchronize the patient, material and information flows. This research describes a method to develop a reliable and valid set of both quality-focused and process-oriented key performance indicators and applies the findings to a case study on the process of hip replacement patients taking the opinion of internal stakeholders into account.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abo-Hamad W, Arisha A (2013) Simulation-based framework to improve patient experience in an emergency department. Eur J Oper Res 224(1):154–166. doi:10.1016/j.ejor.2012.07.028

    Article  Google Scholar 

  • Aidemark L-G (2001) The meaning of balanced scorecards in the health care organisation. Financ Account Manag 17(1):23–40

    Article  Google Scholar 

  • Ambler T (2003) Marketing and the bottom line, 2nd edn. Financial Times Prentice Hall, London

    Google Scholar 

  • Baltacioglu T, Ada E, Kaplan MD et al (2007) A new framework for service supply chains. Serv Ind J 27(2):105–124. doi:10.1080/02642060601122629

    Article  Google Scholar 

  • Bauer K (2004) KPIs—the metrics that drive performance management. DM Rev 14(9):63

    Google Scholar 

  • Becker B, Formisano A, Roger MD (2006) Strategic planning for departmental divisions in an academic health care centre. Am J Med 199(4):357–365

    Article  Google Scholar 

  • Behrouzi FP, Shaharoun AMP, Ma'aram AP (2014) Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Aust Health Rev 38(2):208–217. doi:10.1071/AH06017410.1108

    Google Scholar 

  • Berler A, Pavlopoulos S, Koutsouris D (2005) Using key performance indicators as knowledge-management tools at a regional health-care authority level. IEEE Trans Inf Technol Biomed 9(2):184–192. doi:10.1109/TITB.2005.847196

    Article  Google Scholar 

  • Bohmer RMJ (2009) Designing care: aligning the nature and management of health care. Harvard Business Press, Boston

    Google Scholar 

  • Bothner U, Brinkman A, Gebhard F et al (2003) Balanced scorecard. “Tool or toy” im Krankenhaus? Anaesthesist 52:947–956

    Article  Google Scholar 

  • Botta-Genoulaz V, Millet P-A (2006) An investigation into the use of ERP systems in the service sector. Int J Prod Econ 99(1–2):202–221. doi:10.1016/j.ijpe.2004.12.015

    Article  Google Scholar 

  • Brien SE, Ghali WA (2008) Public reporting of the hospital standardized mortality ratio (HSMR): implications for the Canadian approach to safety and quality in health care. Open Med 2(3):70–73

    Google Scholar 

  • Brown SE, Ratcliffe SJ, Halpern SD (2014) An empirical comparison of key statistical attributes among potential ICU quality indicators. Crit Care Med 42(8):1821–1831. doi:10.1097/CCM.0000000000000334

    Article  Google Scholar 

  • Cardinaels E, Soderstrom N (2013) Managing in a complex world: accounting and governance choices in hospitals. Eur Account Rev 22(4):647–684

    Article  Google Scholar 

  • Caughey GE, Ellett LMK, Wong TY (2014) Development of evidence-based Australian medication-related indicators of potentially preventable hospitalisations: a modified RAND appropriateness method. BMJ Open 4(4):e004625

    Article  Google Scholar 

  • Chen C (2010) Information visualization. Wiley Interdiscip Rev Comput Stat 2(4):387–403. doi:10.1002/wics.89

    Article  Google Scholar 

  • Chukwuani CM, Olugboji A, Akuto EE et al (2006) A baseline survey of the primary healthcare system in South Eastern Nigeria. Health Policy 77(2):182–201. doi:10.1016/j.healthpol.2005.07.006

    Article  Google Scholar 

  • Covaleski MA, Dirsmith MW, Samuel S (2003) Changes in the institutional environment and the institutions of Governance: extending the contributions of transaction cost economics within the management control literature, Accounting. Organ Soc 28(5):417–441

    Article  Google Scholar 

  • De Vito C, Nobile CG, Furnari G et al (2009) Physicians’ knowledge, attitudes and professional use of RCTs and meta-analyses: a cross-sectional survey. Eur J Public Health 19(3):297–302

    Article  Google Scholar 

  • Denton B, Viapiano J, Vogl A (2007) Optimization of surgery sequencing and scheduling decisions under uncertainty. Health Care Manag Sci 10(1):13–24

    Article  Google Scholar 

  • DiMaggio PJ, Powell WW (1983) The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Am Sociol Rev 48(2):147–160

    Article  Google Scholar 

  • Donabedian A (1988) The quality of care: how can it be assessed? JAMA 121(11):1145–1150

    Google Scholar 

  • Dumas M, La Rosa M, Mendling J et al (2013) Fundamentals of business process management. Springer, Berlin

    Book  Google Scholar 

  • Eddy DM (1998) Performance measurement: problems and solutions. Health Aff 17(4):7–25. doi:10.1377/hlthaff.17.4.7

    Article  Google Scholar 

  • Eldenburg L (1994) The use of information in total cost management. Account Rev 69(1):96–121

    Google Scholar 

  • Gale NK, Shapiro J, McLeod HST et al (2014) Patients-people-place: developing a framework for researching organizational culture during health service redesign and change. Implement Sci 9(1):106. doi:10.1186/s13012-014-0106-z

    Article  Google Scholar 

  • Gemmel P, Vandaele D, Tambeur W (2008) Hospital Process Orientation (HPO): the development of a measurement tool. Total Qual Manag 19(12):1207–1217

    Article  Google Scholar 

  • Gooch KL, Smith D, Wasylak T et al (2009) The Alberta Hip and Knee replacement project: a model for health technology assessment based on comparative effectiveness of clinical pathways. Int J Technol Assess Health Care 25(2):113–123. doi:10.1017/S0266462309090163

    Article  Google Scholar 

  • Goodhue DL, Thompson RL (1995) Task-technology fit and individual performance. MIS Q 19(2):213–236. doi:10.2307/249689

    Article  Google Scholar 

  • Greaves F, Millett C, Pape UJ et al (2012) Association between primary care organisation population size and quality of commissioning in England: an observational study. Br J Gen Pract 62(594):e46–e54. doi:10.3399/bjgp12X616364

    Article  Google Scholar 

  • Grigoroudis E, Orfanoudaki E, Zopounidis C (2012) Strategic performance measurement in a health care organisation: a multiple criteria approach based on balanced scorecard. Omega 40(1):104–119. doi:10.1016/j.omega.2011.04.001

    Article  Google Scholar 

  • Harris R, Bridgman C, Ahmad M et al (2011) Introducing care pathway commissioning to primary dental care: measuring performance. Br Dent J 211(11):E22. doi:10.1038/sj.bdj.2011.1005

    Article  Google Scholar 

  • Heselmans A, Donceel P, Aertgeerts B et al (2009) The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines. BMC Fam Pract 10(1):64

    Article  Google Scholar 

  • Howell SC, Wills RA, Johnston TC (2014) Should diagnosis codes from emergency department data be used for case selection for emergency department key performance indicators? Aust Health Rev 38(1):38–43

    Article  Google Scholar 

  • Hsu SH (2011) Cost information and pricing: empirical evidence. Contemp Account Res 28(2):554–579

    Article  Google Scholar 

  • Hunter BM, Requejo JH, Pope I, Daelmans B, Murray SF (2014) National health policy-makers’ views on the clarity and utility of Countdown to 2015 country profiles and reports: findings from two exploratory qualitative studies. Health Res Policy Syst 12:40. doi:10.1186/1478-4505-12-40

    Article  Google Scholar 

  • Institute of Medicine (2001) Committee on the quality of health care in America. Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DC

    Google Scholar 

  • Institute of Medicine (2010) Roundtable on value & science-driven health care. In: Yong P, Olsen L, McGinnis J (eds) Value in health care: accounting for cost, quality, safety, outcomes, and innovation. National Academies Press, Washington, DC

    Google Scholar 

  • Jacobs R, Goddard M, Smith PC (2005) How robust are hospital ranks based on composite performance measures. Med Care 43(12):1177–1184

    Article  Google Scholar 

  • Jacobs R, Mannion R, Davies HTO et al (2013) The relationship between organizational culture and performance in acute hospitals. Soc Sci Med 76:115–125. doi:10.1016/j.socscimed.2012.10.014

    Article  Google Scholar 

  • Jha AK, Orav EJ, Zheng J et al (2008) Patients’ perception of hospital care in the United States. N Engl J Med 359:1921–1931. doi:10.1056/NEJMsa0804116

    Article  Google Scholar 

  • Jorissen A (1994) Prestatiemeting. Naar een betere beheersing van bedrijfsactiviteiten. MAKLU Uitgevers, Antwerpen

    Google Scholar 

  • Kaplan RS, Haas DA (2014) How not to cut health care costs. Harv Bus Rev 64(11):116–122

    Google Scholar 

  • Kaplan RS, Norton DP (2010) The balanced scorecard—measures that drive performance. Harv Bus Rev 1:134–142

    Google Scholar 

  • Kelley ET, Arispe I, Holmes J (2006) Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Health care quality report. Int J Qual Health Care 18(September):50

    Google Scholar 

  • Kollberg B, Elg M, Lindmark J (2005) Design and implementation of a performance measurement system in Swedish health care services: a multiple case study of 6 development teams. Qual Manag Health Care 14(2):95–111

    Article  Google Scholar 

  • Kros JF, Brown E (2012) Health care operations and supply chain management: strategy, operations, planning, and control. Wiley, San Francisco, CA

    Google Scholar 

  • Kumar A, Ow PS, Prietula MJ (1993) Organizational simulation and information systems design: an operations level example. Manag Sci 39(2):218–240

    Article  Google Scholar 

  • Lapointe P (2005) Timken rolls out a marketing dashboard for industrial bearing group. Market NPV 3(1):3–6

    Google Scholar 

  • Lega F, Marsilio M, Villa S (2013) An evaluation framework for measuring supply chain performance in the public health care sector: evidence from the Italian NHS. Prod Plan Control 24(10/11):931–947

    Article  Google Scholar 

  • Lim KH, Benbasat I (2000) The effect of multimedia on perceived equivocality and perceived usefulness of information systems. MIS Q 24(3):449–471

    Article  Google Scholar 

  • Lindenauer PK, Remus D, Roman S et al (2007) Public reporting and pay for performance in hospital quality improvement. N Engl J Med 356(5):486–496. doi:10.1056/NEJMsa064964

    Article  Google Scholar 

  • Liu HC, Itoh K (2013) Conceptual framework for holistic dialysis management based on key performance indicators. Ther Apher Dial 17(5):532–550. doi:10.1111/1744-9987.12019

    Google Scholar 

  • Lux MP, Fasching P, Schrauder M et al (2011) The era of centers: the influence of establishing specialized centers on patients’ choice of hospital. Arch Gynecol Obstet 283(3):559–568

    Article  Google Scholar 

  • Mant J (2001) Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care 13(6):475–480. doi:10.1093/intqhc/13.6.475

    Article  Google Scholar 

  • Mears A, Vesseur J, Hamblin R et al (2011) Classifying indicators of quality: a collaboration between Dutch and English regulators. Int J Qual Health Care 23(6):637–644

    Article  Google Scholar 

  • Meyer JW, Rowan B (1977) Institutionalized organizations: formal structure as myth and ceremony. Am J Sociol 83(2):340–363

    Article  Google Scholar 

  • Miller A, Cioffi J (2004) Measuring marketing effectiveness and value: the Unisys marketing dashboard. J Advert Res 44(3):237–243. doi:10.1017/S0021849904040334

    Article  Google Scholar 

  • Moore MH (2000) Managing for value: organizational strategy in for-profit, nonprofit, and governmental organizations. Nonprofit Volunt Sect Q 29(suppl 1):183–208

    Article  Google Scholar 

  • Naranjo-Gil D, Hartmann F (2007) How CEOs use management information systems for strategy implementation in hospitals. Health Policy 81(1):29–41

    Article  Google Scholar 

  • Northcott HC, Harvey MD (2012) Public perceptions of key performance: Alberta Canada. Int J Qual Health Care 24(3):214–223

    Article  Google Scholar 

  • OECD (2013) Health at a glance: OECD indicators. OECD, Paris. doi:10.1787/health_glance-2013-en

  • Osoba D (2002) A taxonomy of the uses of health-related quality-of-life instruments in cancer care and the clinical meaningfulness of the results. Med Care 40(6):III31–III38

    Google Scholar 

  • Paine KD (2004) Using dashboard metrics to track communication. Strateg Commun Manag 8(5):30–33

    Google Scholar 

  • Panaretto KS, Gardner KL, Button S et al (2013) Prevention and management of chronic disease in Aboriginal and Islander community controlled health services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services. BMJ Open 3(4):e002083. doi:10.1136/bmjopen-2012-002083

    Article  Google Scholar 

  • Parida A, Chattopadhyay G (2007) Development of a multi-criteria hierarchical framework for maintenance performance measurement (MPM). J Qual Maint Eng 13(3):241–258. doi:10.1108/13552510710780276

    Article  Google Scholar 

  • Pauwels K, Ambler T, Clark BH et al (2009) Dashboards as a service: why, what, how, and what research is needed? J Serv Res 12(2):175–189. doi:10.1177/1094670509344213

    Article  Google Scholar 

  • Pizzini MJ (2006) The relation between cost-system design, managers’ evaluations of the relevance and usefulness of cost data and financial performance: an empirical study of US hospitals. Account Organ Soc 31(2):179–210

    Article  Google Scholar 

  • Render M, Freyberg R, Hasselbeck R et al (2011) Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units. BMJ Qual Saf 20(6):498–507

    Article  Google Scholar 

  • Rivard-Royer H, Beaulieu M, Friel T, HEC MontrĂ©al (2003) Groupe de recherche ChaĂ®ne. HEC MontrĂ©al, p 10

    Google Scholar 

  • Sackett DL, Rosenberg W, Gray J et al (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312(7023):71

    Article  Google Scholar 

  • Sadraoui T, Mchirgui N (2014) Supply chain management optimization within information system development. Int J Econ Financ Manag 2(2):59–71

    Google Scholar 

  • Scott WR (2001) Institutions and organizations. Sage, Thousand Oaks, CA

    Google Scholar 

  • Shepherd KD, Farrow A, Ringler C, Gassner A, Jarvis D (2013) Review of the evidence on indicators, metrics and monitoring systems. World Agroforestry Centre (ICRAF), Nairobi, p 6

    Google Scholar 

  • Shohet IM (2006) Key performance indicators for strategic healthcare facilities maintenance. J Constr Eng Manag 132(4):345–352, http://dx.doi.org/10.1061/

    Article  Google Scholar 

  • Smith PC (2005) Performance measurement in health care: history, challenges and prospects. Public Money Manag 25(4):213–220

    Article  Google Scholar 

  • Smith M, Saunders R, Stuckhardt L et al (2013) Best care at lower cost: the path to continuously learning, health care in America. The National Academies Press, Washington, DC

    Google Scholar 

  • Stadler H (2008) Supply chain management—an overview. In: Stadler H, Kilger C (eds) Supply chain management and advanced planning: concepts, models, software and case studies. Springer, Berlin, pp 9–33

    Chapter  Google Scholar 

  • Stelfox HT, Straus SE (2013) Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development. J Clin Epidemiol 66(12):1320–1327

    Article  Google Scholar 

  • Tarantino DP (2003) Using the balanced scorecard as a performance management tool. Physician Exec 29(5):69–72

    Google Scholar 

  • Tashobya CK, Da Silveira VC, Ssengooba F et al (2014) Health systems performance assessment in low-income countries: learning from international experiences. Global Health 10(5):5. doi:10.1186/1744-8603-10-5

    Article  Google Scholar 

  • Ten Asbroek AHA, Arah OA, Geelhoed J et al (2004) Developing a national performance indicator framework for the Dutch health system. Int J Qual Health Care 16(S1):i65–i71

    Article  Google Scholar 

  • Vanhaecht K, De Witte K, Sermeus W (2007) The care process organisation triangle: a framework to better understand how clinical pathways work. J Integr Care Pathw 11(2):54–61. doi:10.1258/j.jicp.2007.169

    Article  Google Scholar 

  • Veillard J, Champagne F, Klazinga N et al (2005) A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. Int J Qual Health Care 17(6):488

    Article  Google Scholar 

  • Villa S, Barbieri M, Lega F (2009) Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Manag Sci 12(2):155–165

    Article  Google Scholar 

  • Vissers J, Beech R (2005) Health operations management: basic concepts and approaches. In: Vissers J, Beech R (eds) Health operations management: patient flow logistics in health care. Routledge, New York, p 344

    Google Scholar 

  • Walters JL, Mackintosh S, Sheppard L (2012) The journey to total hip or knee replacement. Aust Health Rev 36(2):130–135. doi:10.1071/AH11050

    Article  Google Scholar 

  • Weerawat W, Pichitlamken J, Subsombat P (2013) A generic discrete-event simulation model for outpatient clinics in a large public hospital. J Health Care Eng 4(2):285–305

    Article  Google Scholar 

  • Wollersheim H, Faber MJ, Grol RPTM et al (2006) Vertrouwen in verantwoorde zorg? effecten van en morele vragen bij het gebruik van prestatie-indicatoren. Centrum voor Ethiek en Gezondheid, Den Haag

    Google Scholar 

  • Yang C-C, Cheng L-Y, Yang C-W (2005) A study of implementing Balanced Scorecard (BSC) in non-profit organizations: a case study of private hospital. Hum Syst Manag 24(4):285–300

    Google Scholar 

  • Yang SL, Su SI, Chien CW et al (2007) Logistics innovation process model and its application—a case study of a Medical Center in Taiwan. Hosp Health Serv Adm 40(4):72–85

    Google Scholar 

  • Yigitbasioglu OM, Velcu O (2012) A review of dashboards in performance management: implications for design and research. Int J Account Inf Syst 13(1):41–59. doi:10.1016/j.accinf.2011.08.002

    Article  Google Scholar 

  • Yin RK (2013) Case study research: design and methods. Sage, London

    Google Scholar 

  • Zanjirani R, Farahani N, Davarzani H (2009) Supply chain and logistics in national, international and government environment. Springer, Heidelberg

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kaat De Pourcq .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

De Pourcq, K., Gemmel, P., Trybou, J. (2016). Measuring Performance in Hospitals: The Development of an Operational Dashboard to Coordinate and Optimize Patient, Material and Information Flows. In: Albach, H., Meffert, H., Pinkwart, A., Reichwald, R., von Eiff, W. (eds) Boundaryless Hospital. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49012-9_9

Download citation

Publish with us

Policies and ethics