This management truism is placed squarely in a hospital context in this column by Tina Foster, in Health Care's Most Wired Magazine (am I the only one who thinks that's a pretty silly name for a magazine?). In my hospital practice, the biggest barrier to operational improvements is the lack of operational data. This lack of data also represents the greatest sink of my time when working with hospitals. Amazingly, some hospitals spend hundreds of thousands to more than a million dollars having consultants gather operational data - a cost that many times exceeds the price of software systems that can provide just the kind of data that Foster talks about. This is the need and what Foster defines as a dashboard.

A dashboard collects key performance indicators from disparate data
sources, enabling decision-makers to develop and adopt appropriate
plans to support the overall strategic vision. Additionally,
benchmarking performance indicators against an external market
dashboard--one that contains data from peers--can validate the
organization’s targets or raise important questions.

Within any organization, there are varying
and conflicting ideas about how to achieve strategic objectives. In the
absence of focused and reliable data or a defined strategy for using
it, the most vocal opinions will determine how to meet objectives,
which may not be the best route for the organization or the majority of
the stakeholders. This is where a dashboard can be valuable.

There are two general categories of products targeting this need, cluster apps targeting high acuity patient care areas and hospital-wide patient flow and logistics apps. Cluster apps target critical care, the emergency department (ED) and surgery. House wide patient flow apps track and support bed management and the logistics around care delivery across all types of patient beds. Here is Foster's description of the surgery need.

OR directors have multiple demands for their attention, with the
lion’s share going to achieving optimal patient outcomes and meeting
staffing demands. At the same time, their limited business training and
minimal support may not equip them for taking advantage of the abundant
raw data available. Traditional management methodologies can’t keep all
necessary imperatives on the typical OR director’s radar.

The surgical services department is a
primary revenue and cost driver for the vast majority of hospitals.
However, its leadership may not be prepared for the job, making it an
ideal area for a dashboard. According to AHA’s 2006 Hospital Statistics,
surgery typically represents 40 percent to 50 percent of all hospital
revenue and 45 percent to 60 percent of hospital expenses. The OR
director of an average community hospital manages an operating budget
of $14.2 million, according to the OR Manager 2005 annual
survey, but only 17 percent of those directors are supported by a
business manager. And of the OR directors in this group, 34 percent
have graduate-level education and 34 percent have bachelor’s degrees.

Improving the operational efficiency of care delivery does more than just reduce staff overtime or ambulance diversions, patient outcomes and satisfaction are also impacted.

Capacity is the new currency for most
hospitals, especially in the OR, where every 5 percent increase in
surgical volume represents an average 1 percent increase to the
operating margin, according to the Health Care Advisory Board Future of General Surgery 2004
report. For most hospitals, an additional surgical case a day yields an
additional $1 million to $3 million of net revenue per year. In results
from the OR Manager 2005 annual survey, 52 percent of
directors reported an average volume growth of 7 percent. When
decision-makers have access to performance indicators that can be
compared with similar providers, they are better able to manage this
capacity and its impact on the organization as a whole.

In fairness to the cluster and patient flow software vendors alluded to above, there is a lot more entailed than dropping a piece of dashboard software on top of a department - you have to actually have, you know, data. Consultants can provide significant value to their clients, but they can also waste huge budgets while delivering little return. Rather than engaging consultants for expensive manual data gathering efforts, leverage their expertise to select and implement an information system that will provide operational data every day - those kind of engagements are less expensive, and deliver value for the life of the software system you purchase.

At right is a sample dashboard from patient flow logistics vendor, StatCom.

UPDATE: A thoughtful reader leaves this comment:

What about GIGO (Garbage In- Garbage Out)? A dashboard is only as good
as the data that is put into it. It seems like this is where data input
technology such as RFID tags or StatCom's WiBut (from your 2/14 blog
entry) become so crucial.

Certainly a product should have the proper data collection tools (you know, tools people will actually use). Just as important is the implementation, training and ongoing management of the system. Even with good data collection tools, bad habits can compromise data integrity.