As a hospital CEO, it’s easy to spend the whole day responding and reacting, instead of focusing on issues that drive results. Eventually, those days turn into months and you’ve spent all your time addressing the symptoms of problems instead of the problems themselves. Quint Studer, founder of Studer Group, says in Becker’s Hospital Review, “Structure is the solution to reducing chaos.” When the majority of your time is spent taking action on the metrics that matter most, many of the problems that would otherwise take up the day will solve themselves.
So, what issues should a CEO focus on? BHR suggests making a timeline for different categories of issues. The timeline should include tasks to do daily, quarterly, and yearly. The following checkpoints are recommended:

Metrics & Issues to Monitor Daily

*Studer notes: “In a LEAN environment, the CEO might make these actions part of his or her Leader Standard Work list.”

1. Outpatient no-shows. If you notice these numbers are high, you might consider tweaking or changing your reminder system. No-shows hurt productivity and cost the healthcare industry billions every year.
2. First case start-times. This is crucial for keeping the OR running smoothly.
3. Patient volume. How many patients are admitted each day?
4. “Door-to-doc” time in the emergency department. How long are patients waiting to be seen? Studer says, “This has implications for staffing levels, patient safety, and patient and employee satisfaction.” These metrics are available to the public on Medicare Hospital Compare, and patients will use this information to decide which hospital to visit.
5. “Decision to admit to departure” time in ED. After a physician decides to admit a patient to an inpatient bed, how much time passes before the patient leaves the ED for that bed?
6. Number of patients who leave the ED without being seen. If this number is high, it indicates ED crowding and longer ED wait times. Studer says the patients who leave without being seen are more likely to report worsened health problems.
7. Major service issues. If patients are upset, it may be better to handle those situations personally.
8. Major engagement issues. If physicians or employees are upset, it’s imperative to address those issues quickly. Employee engagement not only affects patient safety, but also process improvement. Studer suggests employee and physician satisfaction be regular agenda items at department head and medical executive committee meetings.

Metrics & Issues to Monitor Quarterly

*Studer notes: “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, and outcome measures? These are directly linked to the health of the hospitals’ operating margins.
2. Employee metrics. Are employees satisfied? This may require considering turnover rates. Employee engagement is a necessity in high-performing organizations. Studer suggests holding quarterly employee forums to give employees a chance to be heard.
3. Physician metrics. Don’t forget referral patterns and satisfaction ratings. It’s important that physicians are engaged in hospital operations and view the organization as a great place to practice medicine.
4. Philanthropy. Many organizations visit this once a year, but Studer says quarterly is better when so many hospitals are struggling to sustain themselves. Government funding is getting harder to obtain, making philanthropy even more important. When do donations increase and decrease? Why? Also, be sure to keep the lines of communication open and let donors know where their funds went.
5. Board communications. While this is in the “quarterly” category, it should probably happen more often than that. Communication between board members should happen frequently, and not just at the end of the year. Meet with each board member individually and find out what he or she defines as healthy communication. Studer says, “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. Are your leaders aligned in terms of mindset and resources? Is there a sense of urgency for constant improvement? Do your processes hold people accountable for executing well? There are several leadership assessments available to measure these vital leadership qualities.
2. Audit your evaluation system. Are your leader assessments matching up to the results your leaders are responsible for? If all leaders are scoring high, your organization should be hitting most, if not all, of its goals. Studer says this is often not the case. He suggests using an objective evaluation tool that’s linked to hard goals. If you’re using something subjective, it may be time to re-think your approach.
3. Evaluate contracts. When looking at contracts, the focus should be on cost and performance. If your hospital is ranking low in cleanliness and you outsource those services, it’s time to reevaluate that contract. Where possible, tie performance into contracts with these types of vendors.
While keeping close eyes on the health of your organization may not always be enjoyable, it’s necessary. This may cause some discomfort up front and require adopting new habits, but the long-term gains in your organization’s health will be more than worth it.