KEY PERFORMANCE INDICATORS for Hospital Services … · KEY PERFORMANCE INDICATORS for Hospital Services ... on Key Performance Indicators ... the sense that every time formula or

KEY PERFORMANCE INDICATORS for

Hospital Services

prepared by:

Dr Sohail Iqbal Information System Expert

TRF+, Khyber Pakhtunkhwa

January 10, 2017

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Contents 1. Introduction…………………………………………………………………………………………………………………………………………………………………………………………… 1

2. Objectives……………………………………………………………………………………………………………………………………………………………………………………………… 2

3. System Design……………………………………………………………………………………………………………………………………………………………………………………….. 3

3.1. Management Levels ....................................................................................................................................................................................... 3

3.2. Performance domains .................................................................................................................................................................................... 4

3.3. Performance measures (KPIs) ........................................................................................................................................................................ 5

3.4. Data sources ................................................................................................................................................................................................... 6

3.5. Configuring Scorecards .................................................................................................................................................................................. 7

3.5.1. Benchmarks and Performance Standards .............................................................................................................................................. 8

3.5.3. Weightage / Formula / Scoring Engine .................................................................................................................................................. 8

3.5.4. Cascading Measures ............................................................................................................................................................................. 10

3.6. Processes and tools ...................................................................................................................................................................................... 10

3.6.1. Data collection process ........................................................................................................................................................................ 11

3.6.2. Data capture tools ................................................................................................................................................................................ 11

3.6.3. Web-based data management and reporting system ......................................................................................................................... 11

4. KPIs Summary List of Hospital Services (Total KPIs: 18, Total Score: 90)………………………………………………………………………………………………. 18

5. KPI Details of Hospitals Year: 2016 (Total KPIs: 18, Total Score: 90)……………………………………………………………………………………………………… 20

Annex – 1.1.1 Filled Post Index : Percentage of essential posts filled against sanctioned posts………………………………………………………………………… 38

Annex - 1.1.2 Staff Presence Index : Percentage of staff present……………………………………………………………………………………………………………………… 40

Annex - 1.3.1 : Drug Availability Index (DHIS) Secondary Level…………………………………………………………………………………………………………………………. 41

Annex - 1.3.2 : Essential Equipment Availability and Functionality Index (IMU) Secondary Level……………………………………………………………………… 42

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List of Abbreviations

CMW Community Midwife

DFID Department for International Development

DGHS Director General of Health Services

DHDC District Healthcare Development Center

DHIS District Health Information System

DoH Department of Health

DHO District Health Officer

DDOH Deputy District Health Officer

EPI Expanded Programme on Immunization

FP Family Planning

IMR Infant Mortality Rate

KPI Key Performance Indicator

LHW Lady Health Worker

M&E Monitoring and Evaluation

MDG Millennium Development Goals

MIS Management Information System

MMR Maternal Mortality Ratio

MNCH Maternal, Newborn and Child Health

NP National Programme

PHS Public Health Specialist

HSRP Health Sector Reform Project

RHIS Routine Health Information System

TA Technical Assistance

TBC TB Control

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TOT Training of Trainers

TRF Technical Resource Facility

WFP World Food Programme

WHO World Health Organization

Revised KPIs for District Health Services 2016 – 2017

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1. Introduction

The Government of the Khyber Pakhtunkhwa is committed to provide better health services to its people and took significant initiatives

in this direction. The prime focus is on the health service delivery, i.e. reduction of IMR, MMR and the improvement in mother and

child healthcare services through improving the access, quality and equity of the services.

The overall performance of the Department of Health (DoH) depends on the performance of its managers and health delivery

institutions. The performance can be measured through systematic collection of information (data) and the analysis of outcomes and

its impacts on the society.

Many MIS are functioning within the department, that collect data of the different vertical programees. However, in the context of

devolving and restructuring of the of health programmes, a comprehensive and integrated M&E system is deployed that would provide

basis for performance evaluation at various levels. For this purpose, the DoH took initiative and conceptualized an M&E system that

includes comprehensive system for data collection, reporting and validation. The system comprises of a set of agreed Key Performance

Indicators (KPIs) for monitoring of district health services and measure the performance of managerial / supervisory tiers including

Directorate General of Health Services Khyber Pakhtunkhwa (provincial level) and District Health Officers (District Heath

Management). The system measures the performance and direct corrective actions for the improvement of the health services.

Figure 1.1: Core Functions of Health System

Planning and Management

Monitoring and Supervision

Service DeliveryProgramme

Management

Goals


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The team of consultants held a series of consultative meetings in year 2016-2017 with the key stakeholders of Health Department

Khyber Pakhtunkhwa Including DGHS Khyber Pakhtunkhwa, Provincial coordinator DHIS, Deputy Coordinator DHIS, Project Director

IMU, Deputy Director EPI, representative from HSRU, Project Director Integrated Health Program, Program manager of Provincial TB

Program, M&E officer of MNCH program, Program manager of Hepatitis program, Manager Provincial Malaria Control (PoMC),

Database Administrator DHIS, DHO Swabi, MS of DHQs and THQs and provincial Team Lead TRF+. After a series of meetings and

exhaustive deliberations a final set of KPIs was agreed.

To collect data, a number of existing online and offline data sources have been identified and agreed with the key stakeholders for the

data collection of KPIs. The online data sources include: District Health Information System (DHIS), EPI MIS, LHW MIS, MNCH MIS and

IMU database. The sources regularly collect curative and preventive care indicators from health facilities and vertical / special health

programmes. Moreover, data for KPIs has also been collect from some offline data sources such as Provincial TB Programe (PTP),

Provincial Malaria Control (PoMC) and DGHS and DHO offices.

The M&E system has various management levels that include Directorate General Health Services, District Health Officers (DHO),

Deputy District Officers Health (DDOH) and Medical Superintendents (MS) of secondary care hospitals (DHQ and THQ). The evaluation

is based on Key Performance Indicators (KPI) from existing online and offline data sources as well as additional sources such as

supervisory checklists.

A mechanism for data validation is also been adopted to ensure reporting accuracy. The M&E system is of web-based software which

will be fed by various data sources including DHIS, MISs of vertical programmes. The software processes the data from all the sources

and calculate key performance indicators with balance scorecard methodologies.

2. Objectives

The main objective of the KPI system is to enable the Health Department for unbiased monitoring and performance analysis of various

offices and institutions of the department. The system will improve health service delivery and other services by measuring and

reporting key performance indicators in various domains. The emphasis is on result-based performance and monitoring instead of

process or activities based performance.


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The aim of the assignment is to design and develop a web-based performance monitoring and evaluation system for higher

management through online dashboards by using state of the art technologies. This document therefore presents outline of the

structural design of web-based M&E system as per assigned TORs, Inception Report and discussion with various stakeholders. As

already mentioned, the assignment will also build local capacity of the health department for improvement of the health systems on

sustainable basis.

The proposed structural design will pave a path towards detail designing, development and operations of the M&E system to achieve

overall objectives. On the basis of structural design, a web-based software system is developed and implemented in all districts of

Khyber Pakhtunkhwa for performance monitoring and evaluations.

3. System Design

This section presents structural design of the performance monitoring system, processes, data flows for measuring/capturing and

presentations of calculated KPIs scorecard on the dashboards. The detailed design specifications, particularly related to software

system is prepared during the system development and together with the document, shall form the overall set of technical

documentations to be used as reference material in future for system maintenance and its up-gradation.

3.1. Management Levels

As per assigned Terms of Reference (ToR) and agreed during the technical committee meetings, the following three management

levels of Khyber Pakhtunkhwa Health System have been directed for performance monitoring and evaluation:

1. Office of the Director General of Health Services (provincial level)

2. District Health Officers (25 districts)

3. Medical Superintendents of hospitals (THQs/DHQs)


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Figure 3.1: Management Levels of KPI System

3.2. Performance domains

Performance domains and sub-domains for each of these management units/levels have been defined separately. These domains and

sub-domains relate to the major functions of the specific management unit/level. A list of these performance domain and sub-domains

is given as under:

Management unit/level Domain Sub-domain

DHO


Operational Planning

Human Resources

Financial Management

Medicines/supplies

Emergency transport


Supervisory/monitoring visits

Feedback

MIS

Coordination Coordination

Service Delivery EPI


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Management unit/level Domain Sub-domain

Curative Care

Mother and Child Health

Programme management

National TB Control Programme

National Programme for FP&PHC

MNCH Programme

Malaria Control Programme

Polio Eradication

MS (Hospital)


Human Resource

Financial Management

Medicines/Supplies

Emergency Transport

Monitoring and Supervision MIS

Hospital Management & Services

Service Quality

Service Delivery

Table 3.1: Management Levels / Domains / Subdomains

3.3. Performance measures (KPIs)

A detailed list of quantitative performance measures, or key performance indicators (KPIs), their definition and formula for

computing scores are given in Annexes. A summary is given as under:

Management Level Number of KPIs

District (DHO) 32

Hospital (MS) 18

Table 3.2: No of KPIs of each Management Level

Similarly, for DHO level, 32 unique indicators have been selected of which most indicators are quantifiable measures such as coverage

percentages and proportions while five KPIs are in fact composite indices calculated from other indicators.


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For hospitals or MS level, 18 unique indicators have been selected within three major performance domains. Most of these are

quantifiable measures including percentages and proportions while four KPIs are in fact composite indices calculated from other

indicators.

Software Interface: The system administration module of the software allows adding and changing individual KPIs and their

performance domains.

3.4. Data sources

A range of sources have been identified for data on key performance indicators. These include routine management information

system (DHIS, IMU, MNCH-MIS, EPI MIS and LHW-MIS) as well as third-party monitoring system (TPM/HRSP), special programmes,

office records, and hospital records. A list of data sources including in this system is given as under:

S.No. Data Source Type

1. DHIS Cell DHIS 2. Independent Monitoring Unit IMU Database 3. MNCH Program MNCH MIS 4. EPI Programme EPI MIS 5. LHW Programme LHW MIS 6. TBC Programme MIS 7. Malaria Programme MIS 8. LQAS Monitoring System 9. Director Budget Office Record

10. DHO Office Record 11. Minutes of meeting Office Record 12. MS Office Office Record 13. Minutes of meeting Office record 14. Hospital registers / record Hospital MIS/record

Table 3.3: Data Sources of KPI System


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3.5. Configuring Scorecards

An administrative module, accessible through secure login is used for configuring the scorecard, for adding or changing key

performance indicators, for assigning or changing weights of scorecard and for defining or altering formula of computation.

The scoring/weightage engine is dynamic in the sense that every time formula or weight for a particular KPI is changed, it will re-

calculate performance indices of all management units and time periods according to new configuration.

Figure 3.4: Configuration of KPI System

• Weights

• Scoring formula

• Benchmarks

• Define KPIs

• Linked to domains

• Performance domains and sub-domains

• Defines mgmt levels

• Linked to admin units

• CascadingManagement

LevelsDomains

Scoring Engine

KPIs


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3.5.1. Benchmarks and Performance Standards

For measuring performance according to set of standards, the following benchmarks have been developed after consultation with the

concerned officials of Health Department, Khyber Pakhtunkhwa:

a) For a qualitative indicator having dichotomous values such as yes/no, the scores will be assigned based on full (100% in case of

positive or ‘yes’) or NIL (0% in case of negative or ‘no’).

b) For quantitative indicators having scale variables (percentage or absolute number values), the ceiling/floor cut points is used as

the baseline or benchmark. Individual performance is measured in terms of variance between the KPI value and the benchmark

and scores is assigned based on their relative weightage.

3.5.2. Software Interface:

The system administration module of the software allows changes of benchmarks for individual KPIs and their relative scores. The

system is flexible to accommodate any change in KPIs.

3.5.3. Weightage / Formula / Scoring Engine

Weights to the performance scores is assigned at top management level based on subjective assessment of how important a

performance domain and its measures. The weights are expected to change from time to time as priorities concerning health system

management are changed. The scoring engine of the software is catered for this flexibility requirement through proper authentication

procedure. The rights to change weights is assigned to an authorized user at the provincial level.

The formula for computing performance scores based on KPI value and its relevant weightage is employed on the following methods.

Ceiling and Floor method

Ceiling and Floor are two performance extreme cut point assigned as benchmark. Ceiling is desired level and Floor is undesirable level

for KPI performance value.


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Figure 3.5: Scorecard Process of KPIs

Scorecard is calculated based on KPIs, performance standards/benchmarks and weightage system and converts utilization and service

statistics into scores. The balanced scorecard gives aggregate performance in all performance domains. The scorecard is completely

customizable and can be adapted to any performance management framework.

Figure 3.6: Performance Standards and Scorecard

Validation

Weights

KPI Values

Standards / Benchmarks

Scores


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The Scoring engine of the software is accessible to an authorized user at the provincial level only, who will be able to configure it by

assigning weights, changing scoring methods and formulas.

3.5.4. Cascading Measures

Since the three management units (DGHS, DHO and MS) work in a management hierarchy and the combined performance of a lower

unit reflects the performance of the higher management unit, therefore, overall aggregate performance score of a management unit

is assigned to its next higher unit. For instance, a district performance score will be computed by adding aggregate score of all hospitals

within that district to the performance of the district. Similarly, aggregate district scores will also reflect the performance of the

provincial level management unit (DGHS).

Figure 3.7: Cascading measures of Management Level

3.6. Processes and tools

This section describes processes and tools involved in the performance monitoring system for Khyber Pakhtunkhwa Health

Department.

MS

• Hospitals' aggregate score

DHO

• District's aggregate score

DGHS

• Province's aggregate score


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3.6.1. Data collection process

At each district, the DHIS Computer staff is designated as focal person for collecting M&E data from the sources indicated on KPI sheet.

The data is collected on prescribed forms and then input in the online web-based system either through a web-browser using a

PC/Notebook connected to internet, or in cases where internet connectivity is not readily available, or facing electricity load-shedding

issues, then an Android tablet shall be used to input data through GPRS communication system. The designated DHIS computer staff

of the district will also collect data from the THQ and DHQ hospitals in the district.

Once data will be captured on the form, it will be checked for completeness, consistency and accuracy before entering into the system.

A signed hardcopy shall be filed for record and future reference.

3.6.2. Data capture tools

The following data collection forms are used for capturing data from the sources.

1. Annual KPI sheet

2. Quarterly KPI sheet

3. Monthly KPI sheet

4. Composite indices worksheet

For composite indices such as staff presence index or drugs availability index, separate forms shall be used to input specific data and

calculate composite index value.

3.6.3. Web-based data management and reporting system

Important Design Considerations:

• Flexibility: The software system is designed keeping the “extensibility” as key design element. The software is flexible to allow

changes in performance domains, measures (KPIs), their benchmarks, scoring methods and relative weightage.

• Integration: The structural design and technology platform is taken into consideration for future integration with other systems.

This is particularly important if move towards comprehensive and integrated HIS is made in the future. The performance

management system has easy interfaces with the new online data collection/reporting systems without requiring any significant

changes in its programming code or underlying database.


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• Compliance to standards: Standards for data exchange such as XML is ensured for compatibility of the system across various

platforms.

• Layered approach:

Main modules of Online Software:

a. Data capture/entry module

b. Configuration module

c. Executive dashboard

d. WebGIS for spatial presentation of performance data

e. System administration

Web application:

It facilitates online extraction of data from various sources including DHIS, as well as other data systems. An admin control panel

enables the system administrator to configure the scoreboard and control access, whereas a data management user interface

allows sub-offices to upload their KPI data.


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Figure 3.8: Web Application System Architecture


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WEB-BASED PERFORMANCE MONITORING SYSTEM FOR KHYBER PAKHTUNKHWA HEALTH DEPARTMENT

SYSTEM ARCHITECTURE DIAGRAM

Figure 3.9: Cascading Measures of KPIs

Revised KPIs of Hospital Services 2016 – 2017

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KPI dashboard:

KPI dashboard is an online highly interactive user interface that allows managers to view and analyze performance from different

viewpoints. Depending upon the level of management hierarchy, the dashboard provides relevant view to its end-users.

Currently available on web-browsers, this can be extended to mobile gadgets such as tablets and smartphones.

The dashboards are built for using latest GIS and charting tools that provide ranking, comparison and drill-down facilities to end-

users.

Technology Platform

The following technology options have been selected for various components of this online system:

1. Web-based forms PHP

2. Web database Postgres

3. Dashboard Graphs Fusion Charts


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Figure 3.10: Provincial Level KPI Dashboard for Hospital Performance


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Figure 3.11: Hospitals KPI Dashboard


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4. KPIs Summary List of Hospital Services (Total KPIs: 18, Total Score: 90)

Domain Subdomain KPIs Weight Value Type

Performance Range Interval

Data Source


(30)

Human Resource (10)

Filled Posts Index 5 % THQ= [80 - 50] DHQ= [80 - 50]

M IMU

Staff Presence Index 5 % THQ= [80 - 50] DHQ= [80 - 50]

M IMU

Financial Management (5) Budget Consumption 5 % THQ= [80 - 50] DHQ= [80 - 50]

Annual MS Office

Medicine/Supplies (10)

Drug Availability 5 % THQ= [80 - 50] DHQ= [80 - 50]

M DHIS

Equipment Availability / Functionality 5 % THQ= [80 - 50] DHQ= [80 - 50]

M IMU

Emergency Transport (5) Ambulance Utilization 5 Per

Ambulance THQ: [15 - 5]

DHQ: [30 - 10] Q DHIS


(15) Monitoring/Supervision (15)

Administrative Review Meetings 5 % THQ=[80 – 50] DHQ=[80 - 50]

Q MS Office

Clinical Audits 5 Y/N THQ=[1 – 0] DHQ=[1 - 0]

Q MS Office

Referrals 5 %

THQ= [30 - 10] DHQ= [10 - 0]

(Inverse) Q MS Office

Service Delivery (45)

Service Quality (5) Protocols and guidelines Displayed for IMCI, IYCF, EmOC, Infection prevention, infectious diseases and waste management

5 Y/N THQ=[1 – 0] DHQ=[1 - 0]

M IMU

Service Delivery (40)

Health Facility Utilization Rate (Average Daily OPD)

5 Number THQ=[150 - 250] DHQ= [300 - 400] M DHIS

Bed Occupancy Rate 5 Rate THQ = [70 - 40] DHQ = [80 - 50]

M DHIS


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Average Length of Stay 5 Days THQ = [1 - 2] DHQ = [1 - 3]

M DHIS

OT Services Availability 5 % THQ=[100 – 50] DHQ=[100 - 50]

M DHIS

Lab Services Availability 5 % THQ=[60 – 40] DHQ=[80 - 60]

M DHIS

Comprehensive EmONC Services Status 5 Y/N THQ=[1 – 0] DHQ=[1 - 0]

Q IMU

Total Institutional Deliveries 5 Number THQ=[20 – 40]

DHQ=[40 - 100] M DHIS

Cesarean Section Services 5 Y/N THQ=[1 - 0] DHQ=[1 - 0]

M DHIS


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5. KPI Details of Hospitals Year: 2016 (Total KPIs: 18, Total Score: 90)

1. Domain: Planning & Management Weight 30

1.1 Sub-domain: Human Resource Weight 10

1.1.1 KPI: Filled Posts Index Definition Essential posts filled against sanctioned posts

Data Capture Point IMU

Data Entry Method Automatic

Interval Monthly

Data Type Percentage Value

Criteria / Formula Composite index calculated from sanctioned filled and vacant posts

(See in Annex 1.1.1 for detailed calculation method)

Performance Range THQ: [80 - 50]

DHQ: [80 - 50]

Scoring formula Performance >= Upper Limit Score = 5

Performance <= Lower Limit Score = 0

Otherwise Score = ((Performance – Lower Limit)/(Upper Limit – Lower Limit)) x 5

Weight 5

Discussion


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1.1 Sub-domain: Human Resource Weight 10

1.1.2 KPI: Staff Presence Index Definition Staff not absent from duty at the time of monitoring visit


Interval Monthly


Criteria / Formula Composite index (See in Annex 1.1.2 for detailed calculation method)



DHQ: [80 - 50]

Scoring formula

Performance >= Upper Limit Score = 5


Otherwise Score = ((Performance – Lower Limit)/(Upper Limit – Lower Limit)) x 5

Weight 5

Discussion


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1.2 Subdomain: Financial Management Weight 5

1.2.1 KPI: Budget Consumption Definition

% budget consumption as actual expenditure versus budget released on selected budget items Salary and non-Salary (medicines, POL, Utilities, M&R)

Data Capture Point MS office as well as from provincial accounts office

Interval Annually


Criteria / Formula Numerator: Expenditure on selected Budget items

Denominator: Released Budget

Data Entry Method Manual (by DHIS Cell)


DHQ: [80 - 50]

Scoring Formula

Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5

Weight 5

Discussion

• Data capturing point for the KPI is DHIS

• This will be captured from DHIS Monthly report of June where accumulative budget release and consumption value during year should be stored


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1.3 Subdomain: Medicines/Supplies Weight 10

1.3.1 KPI: Drug Availability Definition Essential medicines availability and balance

Data Capture Point DHIS

Interval Monthly

Data Type Percentage value

Criteria / Formula

Composite index Calculated from Drug availability mentioned in Annex 1.3.1

Numerator: No of Drugs Available

Denominator: No of Essential Drugs mentioned in the list



DHQ: [80 - 50]

Scoring Formula


Weight 5

Discussion


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1.3. Subdomain: Medicines/Supplies Weight 10

1.3.2 KPI: Equipment Availability / Functionality

Definition Availability and Functionality of essential diagnostic equipment at the hospital


Interval Monthly

Data Type Percentage value

Criteria / Formula

Composite index Calculated from equipment list mentioned in Annex 1.3.2

Numerator: No of functional equipment

Denominator: Total No of Essential equipment mentioned in the list



DHQ: [80 - 50]

Scoring Formula


Weight 5

Discussion From secondary tool – for THQ, DHQ, Cat C and D hospitals


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1.4. Subdomain: Emergency Transport Weight 5

1.4.1 KPI: Ambulance Utilization Definition

Utilization of Ambulance in Hospital for emergency transfer of Patients (Per Ambulance Patients transfer)


Interval Quarterly

Data Type Per Ambulance Patient Transfer

Criteria / Formula Numerator: No of Patients transfer through Ambulance in a Quarter

Denominator: No of Functional Ambulance in Hospitals

Data Entry Method Manual


DHQ: [30 - 10]

Scoring Formula


Weight 5

Discussion


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2. Domain: Monitoring & Supervision Weight 15

2.1 Subdomain: Monitoring & Supervision Weight 15

2.1.1 KPI: Administrative Review Meetings Definition

Review meetings on KPIs and DHP Implementation and % of action items addressed

Data Capture Point MS Office – Minutes of Meeting

Interval Quarterly


Criteria / Formula Numerator: # of action points addressed from previous quarter

Denominator: Total number of action points to be addressed

Data Entry Method Manual (by DHIS Coordinator – after reviewing minutes of the meeting)


DHQ: [80 - 50]

Scoring formula


Weight 5

Discussion


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2.1.2 KPI: Clinical Audits Definition Clinical Audits Held in the hospital

Data Capture Point MS Office – Minutes of Meeting

Interval Quarterly

Data Type Yes/No

Criteria / Formula Yes = 1, No=0

Data Entry Method Manual ( by DHIS Coordinator – after reviewing evidence of audit and verified by DMO)


DHQ: [1 - 0]

Scoring Formula Performance = 1 Score = 5 Performance = 0 Score = 0

Weight 5

Discussions


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2.1.3 KPI: Referrals Definition Total Referral from the hospital

Data Capture Point MS Office

Interval Quarterly


Criteria / Formula Numerator: Total Number referred to other Hospital

Denominator: total number of emergency patients

Data Entry Method Manual (by DHIS Coordinator – after reviewing hospital records)

Performance Range

THQ: [30 -10]

DHQ: [10 - 0] (Inverse)

Scoring formula Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5

Weight 5

Discussions


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3. Domain: Service Delivery Weight 45

3.1 Subdomain: Service Quality Weight 5

3.1.1 KPI: Protocols and Guidelines Displayed for IMCI, IYCF, EmOC, Infection Prevention, Infectious Diseases and Waste Management

Definition Protocol and guidelines displayed for IMCI, IYCF, EmOC, Infection prevention, infectious diseases and waste management displayed


Interval Monthly

Data Type Yes / No

Criteria / Formula Yes=1, No=0


Performance Range THQ = [1 - 0] DHQ = [1 - 0]

Scoring formula Performance = 1 Score = 5

Performance = 0 Score = 0

Weight 5

Discussion


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3.2 Subdomain: Service Delivery Weight 40

3.2.1. KPI: Health Facility Utilization Rate (Average Daily OPD)

Definition Average no outdoor patient visited hospital per day


Interval Monthly

Data Type Number

Criteria / Formula Numerator: Total OPD attendance (New + Follow up)

Denominator: Number of working days


Performance Range Benchmarks

THQ = [150 - 250] DHQ = [300 - 400]

Scoring Formula Performance >= Upper Limit Score = 5


Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5

Weight 5

Discussion


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3.2.2 KPI: Bed Occupancy Rate Definition Per day average filled Beds in hospital


Interval Monthly


Criteria / Formula Numerator: Average Beds filled daily

Denominator: Total Number of Beds



Scoring Formula




Weight 5

Discussion


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3.2.3 KPI: Average Length of Stay Definition The number of days a patient stayed in a hospital for treatment.


Interval Monthly

Data Type Days

Criteria / Formula Numerator: Total inpatient days

Denominator: Total discharges.






Weight 5

Discussion


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3.2.4 KPI: OT Services Availability Definition

Hospital provided Surgical Procedure performed under General Anesthesia and Spinal Anesthesia


Interval Monthly

Data Type %

Criteria / Formula

Numerator: Does GA performed more than one (1/0) + Does SA performed more than one 1/0)

Denominator: 2 (GA and SA Provided from DHIS List)



Scoring Formula Performance = 1 Score = 5 Performance = 0 Score = 0

Weight 5

Discussion


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3.2. Subdomain: Service Delivery Weight 40

3.2.5 KPI: Lab Services Availability Definition Essential Lab services provided in the hospital


Interval Monthly

Data Type %

Criteria / Formula Numerator: Does CT Scan performed more than one (1/0) + Does Ultrasonographies performed more than one (1/0) + Does ECG performed more than one (1/0) + Does X-Rays performed more than one (1/0) + Does Lab Investigations performed more than one (1/0)

Denominator: 5 (Essential Lab Services Provided e.g. CT Scan, Ultrasonographies, ECG, X-Rays, Lab Investigations)


Performance Range THQ = [60 - 40] DHQ = [80 – 60]




Weight 5

Discussion


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3.2.6 KPI: Comprehensive EmONC Services Status

Definition Nine Signal of Comprehensive EmONC Services available in the hospital ?



Interval Quarterly

Data Type Yes / No



Scoring formula Performance = 1 Score = 5 Performance = 0 Score = 0

Weight 5

Discussion


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3.2.7 KPI: Total Institutional Deliveries Definition Number of Deliveries Conducted in the hospital

Data Capture Point Online DHIS

Interval Monthly

Data Type Number

Criteria / Formula Number of Deliveries Conducted in a month



Scoring formula




Weight 5

Discussions


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3.2.8 KPI: Cesarean Section Services Definition Cesarean Section perform in Hospital during month


Interval Monthly

Data Type Yes / No




Scoring formula Performance = 1 Score = 5 Performance = 0 Score = 0

Weight 5

Discussions


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Targets, Criteria and Formulas of Composite Index KPIs

Annex – 1.1.1 Filled Post Index : Percentage of essential posts filled against sanctioned posts

Facility Type THQ DHQ

Criteria

Essential Staff Sanctioned Weight Sanctioned Staff Sanctioned Weight

Specialists Doctors 4 20 Specialists Doctors 8 20

MO (Male) 2 15 MO (Male) 3 15

MO (Female) 1 15 MO (Female) 1 15

Dental Surgeon 1 5 Dental Surgeon 1 5

Nurses 3 10 Nurses 10 10

Medical Technician 2 10 Medical Technician 3 10

EPI Technician 1 5 EPI Technician 1 5

LHV 2 10 LHV 5 10

Cleaners 3 5 Cleaners 4 5

Ambulance Drivers 1 5 Ambulance Drivers 2 5

20 100 38 100

Filled Post index of THQ = (No of Specialist post filled (max 4) / 4) * 20 +

(No of MO (Male) post filled (max 2) / 2) * 15 +

(No of MO (Female) post filled (max 1) / 1) * 15 +

(No of Dental Surgeon post filled (max 1) / 1) * 5 +

(No of Nurses post filled (max 3) / 3) * 10 +

(No of Medical Technician post filled (max 2) / 2) * 10 +

(No of EPI Technician post filled (max 1) / 1) * 5 +

(No of LHV post filled (max 2) / 2) * 10 +

(No of Cleaner post filled (max 3) / 3) * 5 +

(No of Ambulance Driver post filled (max 1) / 1) * 5


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Filled Post index of DHQ = (No of Specialist post filled (max 8) / 8) * 20 +

(No of MO (Male) post filled (max 3) / 3) * 15 +

(No of MO (Female) post filled (max 1) / 1) * 15 +

(No of Dental Surgeon post filled (max 1) / 1) * 5 +

(No of Nurses post filled (max 10) / 10) * 10 +

(No of Medical Technician post filled (max 3) / 3) * 10 +

(No of EPI Technician post filled (max 1) / 1) * 5 +

(No of LHV post filled (max 5) / 5) * 10 +

(No of Cleaner post filled (max 4) / 4) * 5 +

(No of Ambulance Driver post filled (max 2) / 2) * 5


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Annex - 1.1.2 Staff Presence Index : Percentage of staff present

Facility Type THQ / DHQ

Criteria

Essential Staff Positions

Specialists Doctors

MO (Male)

MO (Female)

Dental Surgeon

Nurses

Medical Technician

EPI Technician

LHV

Cleaners

Ambulance Drivers

Formula Formula: (Staff present / Staff filled in above positions) * 100


41

Annex - 1.3.1 : Drug Availability Index (DHIS) Secondary Level

Drug List: (18 Essential Medicines and 9 Vaccine for all HF type included in DHIS)

Criteria

Essential Medicine List (From DHIS) Vaccine List (From DHIS)

Cap. Amoxicillin Syp. Amoxicillin Tab. Contrimoxazole Syp. Cotrimoxazole Tab. Metronidazole Syp. Metronidazole Inj. Ampicillin Tab. Diclofenac Syp. Paracetamol Inj. Diclofenac Tab. Chloroquin Syp. Salbutamol Syp. Antihelminthic I/V infusions Inj. Dexamethasone Tab. Iron / Folic Acid ORS Oral pills (COC)

BCG vaccine Pentavalent vaccine Polio vaccine Heptatitis-B vaccine Measles vaccine Tetanus Toxiod Anti Rabies Vaccine Anti Snake Venom Vaccine Syringes


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Annex - 1.3.2 : Essential Equipment Availability and Functionality Index (IMU) Secondary Level

Essential Equipment List

Criteria

To be decided

KEY PERFORMANCE INDICATORS for Hospital Services … · KEY PERFORMANCE INDICATORS for Hospital Services ... on Key Performance Indicators ... the sense that every time formula or

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