Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 19 The Hospital CEO's Ultimate Dashboard: What to Check Daily, Quarterly and Yearly By Quint Studer, Founder of Studer Group T he job of a hospital CEO can be overwhelming. There are so many areas to oversee, decisions to make and problems to solve. If you aren't careful, you'll spend your whole day responding and reacting instead of laser-focusing on the issues that drive results. Before you know it, those days turn into weeks that turn into months that turn into years. Eventually you come to see that you've spent most of your valuable time addressing the symptoms of problems instead of the problems themselves. The solution to reduce chaos is to create structure. When you consistently and deliberately take aggressive action on the metrics that matter most, many of the peripheral problems that would otherwise take up your day will solve themselves. So what are the big issues a CEO should focus on? In my experience, they fall into four "buckets:" productivity, volume, clinical quality and service. I find it's helpful to break these categories into specifics and put them into a timeline. There are three categories of tasks — those to do yearly, quarterly and daily. I recommend the following checkpoints: Metrics and issues to monitor daily 1. Outpatient no-shows. Patient no-shows hurt productivity and cost the healthcare industry billions each year. If you notice your hospital's numbers are running high, it might be time to tweak your reminder system or switch to a better one. 2. First case start-times. Prompt start times are crucial for preventing delays and bottlenecks, and for keeping the OR running smoothly. 3. Patient volume. How many admissions are in the hospital each day? 4. "Door-to-doc" time in the emergency department. How long do patients wait to be seen by a physician in the ED? This has implications for staffing levels, patient safety, and patient and employee satisfaction. This metric, the following two items and other wait times for certain care processes are available to the public on Medicare Hospital Compare. Patients may compare your wait times with those of your competitors to decide which hospital to visit. 5. "Door-to-bed" time in the ED. How long does it take from the time the ED physician decides to admit patients to an inpatient bed and the time the patients actually left the ED for that bed? 6. Number of patients who leave without being seen in the ED. Studies have shown LWBS visits are an indication of ED crowding and are associated with longer ED wait times. Patients are who leave the ED without being seen are more likely to report worsened health problems. 7. Agency and overtime costs. You must look at agency costs constantly, because you are paying a premium price for hospital labor. This may be a temporary cost if labor is assigned for a certain project, but most of the time, high agency costs are because the hospital has a turnover issue, a recruitment issue or — most often, in my opinion — a retention issue. All three of these are strongly correlated with engagement issues. If I have high agency costs, I might also have lower patient experience costs because there are employees who don't know each other and aren't familiar with the health system. 8. Major service issues. Are any patients upset? If so, it may be a good idea to handle these situations personally. 9. Major engagement issues. Are any physicians or employees upset? This is the time to address major issues in employee or physician morale. Employee engagement affects patient safety and process improvement. That one number can impact all sorts of things. Metrics and issues to monitor quarterly While most of these issues need to be looked at continually, I recommend an intensive review of them at least four times a year. 1. Quality metrics. How are the hospital's HCAHPS results? Process of care measures? Outcome measures? Pay-for-performance changes make these benchmarks particularly "hot," as they are directly linked to the health of hospitals' operating margins. 2. Employee metrics. Are employees satisfied? How are turnover rates? Employee engagement is essential to high-performance organizations. I suggest holding employee forums quarterly to give employees a chance to be heard. 3. Physician metrics. This includes referral patterns as well as satisfaction ratings. It's important to ensure physicians are deeply engaged in hospital operations and that they see your organization as a great place to practice medicine. 4. Philanthropy. While most organizations zero in on philanthropy once a year, quarterly is better in a time when so many hospitals are struggling to sustain themselves. With government funding getting harder and harder to obtain, philanthropy grows more important. Keep an eye on donations. Know when donations increase and decrease, and understand why. A challenge with many hospitals' fundraising is the tendency to ask for money once a year. I think it's so powerful if the people who donate money receive regular feedback about where their funds went. 5. Board communication. Make sure this takes place vigorously and often. The end of the year is too late. Most hospital CEOs are never formally measured on board communication. They assume that, because they go to board meetings, they're communicating fine. If there's a problem, it festers and will one day explode. The CEO should meet with every board member individually and ask him or her what they define as healthy communication. This is about clarifying expectations and measuring them so the CEO is not surprised when an issue comes to head. Steps to take annually 1. Hold an intensive leadership assessment. How aligned are your leaders in terms of mindset and resources? Is there a universal sense of urgency regarding the need for constant improvement? Are you taking the right ac-

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