Hospital Improvement

Hospital Improvement
Hospital Improvement was established with a vision of providing healthcare facility managers and performance improvement teams with a comprehensive clearinghouse of benchmarking, performance improvement tools and assisted guidance on the implementation of healthcare facility improvement plans.

Healthcare providers around the world are faced with the competing challenges of adapting to the changing epidemiological and demographic challenges while at the same time improving operational efficiency to drive lower costs and improve quality. Payors are also placing additional pressure on providers to improve quality and efficiency. provided a number of initiatives that will assist your organization with the following objectives:

    • Adopt a performance improvement philosophy including using benchmark information to identify opportunities for improvement
    • Reduce overhead costs, including creating a leaner management structure
    • Reduce waste of supplies
    • Lessen impact of internal inefficiencies due to small units and inefficient processes
    • Better align skill mix with patient care need. Improve the use of paid hours and dollars, through decreased overtime and improvements to sick time identified through benchmarking
    • Identify additional opportunities to reduce costs through the benchmarking of supply chain segments and other key inputs uses an approach to improving clinical and service quality that includes three key processes: measurement, analysis and improvement. Important patient care and service processes and outcomes are measured through the use of quality indicators and data collection techniques. Analysis of the collected data is accomplished through statistically valid techniques to determine levels of performance and quantify variation in processes and outcomes. Where there is an identified opportunity for improvement, the decision to act will depend upon a prioritization process that considers factors such as the impact on patient care and outcomes, customer satisfaction, relevance to the mission and strategic plan, and the extent to which the improvement is required by oversight or regulatory entities. offers our visitors an opportunity to use a maturity model to assess institutional ‘readiness’ for implementation. The idea of a maturity assessment comes from the software industry which needs to assess their ability to use sophisticated software development tools. Similarly, hospitals can self-assess how far along they are in being able to use improvement tools such as Lean. This evaluation can also lead to specific online or consulting support so that healthcare facilities become more mature.


Plan Do Study Act

When an opportunity for improvement is prioritized for action, will employ a Plan-Do-Study-Act (PDSA) methodology to recommend, or guide, the hospital manager to make the improvement. Within PDSA, DMAIC is the six sigma model which provides a set of tools outlined in five chronological phases: Define, Measure, Analyze, Improve and Control.


    • Define: Develop a clear project charter that identifies processes to be improved that are relevant to customer needs and that will provide significant benefits to the hospital.
    • Measure: Determine the baseline and target performance of the process, define key input and output variables and validate the measurement system.
    • Analyze: Use data to find the root cause of the problem; to understand and quantify their effect on process performance.
    • Improve: Identify process improvements to optimize process outputs and reduce variation.
    • Control: Document, monitor and assign accountability for sustaining gains made by the process improvements. 
The DMAIC approach when combined with PDSA ensures that a standardized approach to process improvement is followed and that the voice of the customer is reflected within the process improvement.



Business Model

The business model is basically divided into four levels of access for facility managers.

Level one responds to basic access to benchmarking information for healthcare facility managers. Managers put in their information on key inputs and describe their general situation including performance aspects such as financial stability, patient satisfaction, clinical quality, leadership and organization capability, technology, facility, government regulation and relationship. Once all the information is gathered, metrics will be presented in comparison with peer hospitals worldwide.

Level two allows the healthcare facility to identify through benchmarking or a top down decision, which areas in the facility require improvement. Based on this assessment, then the facility manager chooses the appropriate tool for performance improvement and develops a hospital improvement plan (HIP) based on the guidance provided on the website.

At level three, the facility manager will be allowed to remotely consult with a thematic expert (such as supply chain expert or operating theater turnaround expert) to discuss the hospital improvement plan strategies and provide recommendations on how to move forward.

At level four, the will facilitate an onsiteconsultation to discuss implementation of the improvement strategy formulated based on the website tools.

Affiliation with is open to individual facilities or to hospital associations who wish to cover all of their members with the service.


Hospital Improvement indicators

The following chart includes the Quality Indicators (QI) to help quality leaders and analysts calculate their Hospital Improvement QI rates and identify documentation and coding issues that can affect those rates.


Clinical Quality Indicators
  • Esophageal Resection Volume
  • Pancreatic Resection Volume
  • Abdominal Aortic Aneurysm Repair Volume
  • Bypass Graft Volume
  • Percutaneous Transluminal Coronary Angioplasty Volume
  • PTCA Mortality Rate
  • Carotid Endarterectomy Volume
  • CEA Mortality Rate
  • Esophageal Resection Mortality Rate
  • Pancreatic Resection Mortality Rate
  • Abdominal Aortic Aneurysm Repair Mortality Rate
  • Coronary Artery Bypass Graft Mortality Rate
  • Craniotomy Mortality Rate
  • Hip Replacement Mortality Rate
  • Acute Myocardial Infarction Mortality Rate
  • Acute Myocardial Infarction Mortality Rate, Without Transfer Cases
  • Congestive Heart Failure Mortality Rate
  • Acute Stroke Mortality
  • Gastrointestinal Hemorrhage Mortality Rate
  • Hip Fracture Mortality Rate
  • Pneumonia Mortality Rate
  • Cesarean Delivery Rate
  • Primary Cesarean Delivery Rate
  • Vaginal Birth after Cesarean Rate, Uncomplicated
  • Vaginal Birth after Cesarean Rate, All
  • Laparoscopic Cholecystectomy Rate
  • Incidental Appendectomy in the Elderly Rate
  • Bilateral Cardiac Catheterization Rate
  • Coronary Artery Bypass Graft Area Rate
  • Percutaneous Transluminal Coronary Angioplasty Area Rate
  • Hysterectomy Area Rate
  • Laminectomy or Spinal Fusion Area Rate


Process & Operating Quality Indicators

Clinical Effectiveness

Process of Care

  • primary cesarean section delivery
  • appropriateness of prophylactic antibiotic use for selected tracer use

Outcomes of Process of Care

  • Mortality for selected tracer conditions and procedures
  • readmission for selected tracer conditions/procedures within the same hospital
  • Admission after day surgery for selected tracer procedures
  • Return to higher level of care (e.g. from acute to intensive care) for selected tracer conditions and procedures within 48 h
  • Sentinel events



  • ambulatory surgery use
  • admissions on day of surgery

Input related to output

  • medium (or average) length of stay for specific procedures and conditions: hip replacement, CABG, diabetes and asthma, appendectomy

Use of Capacity

  • inventory in stock
  • operating rooms unused sessions

Staff orientation (or staff responsiveness)

Perspectives and recognition of individual needs

  • staff training

Behavioral Responses

  • short term absenteeism
  • long term absenteeism

Staff Safety

  • Staff excessive weekly working time
  • Percutaneous injuries

Responsive Governance

System / community integration

  • discharge letters to general practitioners with maximum period of two weeks
  • waiting time for selected procedures and conditions (take in account variance of waiting times): hip replacement, hallux valgus, varicose veins surgery, breast cancer surgery, cataract surgery, cardiac surgery (differentiated by degree of emergency)
  • breast feeding at discharge

Patient Centeredness

Client Orientation

  • score on patient experience/satisfaction questionnaire, including items on:  overall perception/satisfaction, interpersonal aspects, client orientation: information, empowerment and continuity

Respect for Patients

  • cancelled one day surgical procedures


Financial Quality Indicators
  • Cash flow margin
  • days cash on hand
  • debt service coverage
  • long-term debt to capitalization
  • medicare outpatient cost to charge
  • profit per inpatient discharge (adjusted for wage index and case mix)
  • administrative service expense as a percentage of total expense
  • information system expense as a percentage of total expense
  • cost per weighted case (relative cost efficiency of a hospitals ability to provide acute inpatient care)
  • clinical lab total worked hours per weighted case
  • diagnostic services total worked hours per weighted case
  • nursing inpatient services total worked hours per weighted case
  • pharmacy total worked hours per weighted case
  • unit-producing personnel worked hours for patient care functional centres as a percentage of total worked hours
  • average age of equipment

Staff orientation (or staff responsiveness)

  • training expenditure
  • health promotion expenditure




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