Case West Central Hospital


Case:West Central Hospital

Part 1: Individual MetricsBeloware the metrics for West Central Hospital

  1. The number of hospital-acquired Pressure Ulcers in a 1,000 Inpatient Discharges

This is expressed as the ratio of the patients who acquired pressureulcers to 1000 discharges for the inpatients. The ratio wasincreasing consistently from 2007 to 2009, rising from 0.4 to 0.7, a75% increase. This data is from patient data for those who gottenpressure while they were still in hospital. Normally, theHospital-Acquired Conditions entails medical conditions orcomplications that develop after the patient is admitted in hospitalas a result of accidents or errors during the administration oftreatment. The rise in hospital-acquired pressure ulcers ratio inWest Central Hospital reflects a gap in the effectiveness of thehospital to protect its patients and prevent occurrence of such theHACs. For instance, the pressure ulcers normally occur when thepatients are not treated as expected and are left in one position fora long time, mainly in wheelchair or bed.

Thesecan be prevented using some known precautions. These include

  • Develop a standard for Leadership Systems and Structure

The West Central Hospital should ensure the senior officials, localcommunity and patients are involved in monitoring the safety of thepatients and develop an integrated safety program for the patient, aswell as come up with sufficient budget that will enhance the safetyof the patients.

  • Develop a culture of performance measurement

The West Central Hospital should develop an annual culture of safetysurvey with a sample of 50% of combined care given to inpatients andshould cover the patient safety units exposed to highest risk. WCHshould share the results within the entire administration and acrossall staff involved with patient safety, as well as implement thehospital-wide policies based on the results of the survey.

  • Teamwork and Team Building Trainings

All the staff should be trained semi-annually on area of teamwork,program budget and patient safety. Also, the staff must be trained onrisk assessment and risk mitigation activities.

  • Develop standards for Nursing Workforce

Hospitals should conduct and implement critical elements of a nursingworkforce that is well designed to mutually reinforce the inpatientsafeguards, including adequate resourced staffing plan for thenurses. This must also include sufficient funding for all the nursingservices and related support in maintenance of skills andprofessional skills and knowledge. Also, the hospital should conductevaluation on severity and frequency of the ventilator-associatedcomplications. The senior officials must always be held accountablefor the performance improvement.

  1. The central line-associated Blood Stream Infections per a 1,000 Catheter Days in the Adult ICU Patients

Thisis expressed as a ratio of the central line-associated blood streaminfections to a 1,000 Catheter Days within the Adult ICU Patients.The ratio increased from 1.6 in 2007 to 2.3 in 2008, equivalent to44% increase, and decreased by 35% from 2.3 in 2008 to 1.5 in 2009.This data is from patient data for those who gotten pressure whilethey were still in hospital. The increase in the ratio from 2007 to2008 reflects a gap in management of the infections while a reductionin 2009 shows an improvement in management.

Nevertheless,the management need to improve the metric further by:

  • Removing the non-essential CVCs: Prompt removal of the unwarranted CVCs is critical in reducing the reducing the ratio. This increases the awareness of the presence of CVC as well as the ongoing risk-benefit assessment of the central venous access.

  • Chlorhexidine Cleansing: the patients should be bathed daily using chlorhexidine-based solution in the ICU-Care Units.

  • Anti-infective locks: a catheter lock entails instillation of the supra-physiologic doses of the anti-infective solution to the catheter lumen between the CVC access periods.

  • Systemic antibiotic prophylaxis: the routine prophylaxis of the antibiotic is critical in reducing the infections.

  1. The percent Return On Total Assets

This is expressed as the ratio of total assets to the total sales.The ratio increased by 49% from 8.58 in 2007 to 12.76 in 2008, andthereafter decreased by 34% from 12.76 in 2008 to 8.4 in 2009. Thisdata is gotten from the financial statements of the hospital.Ideally, percent return on assets can be used to assess the earningsof an enterprise as a percentage of capital investments made so as toachieve those earnings. A higher value is more preferred. The factthat West Central Hospital increase the ROA in 2007-2008 and reducedin 2008-2009, is an indication that the revenue generated using thehospital assets cannot be correlated directly, hence the need to putmore control measures. Ideally, a higher value than previouslyrecorded value indicates a positive trend. This can be improvedthrough:

  • Reducing Cost of Assets: This can be achieved by monitoring the assets monthly through proper management of the inventory levels so as to reflect the expectations of the sales. Excess inventory is a recipe for increased asset costs at constant income.

  • Increasing revenue: The West Central Hospital management must seek avenues of increasing revenues without necessarily increasing the costs for the assets. This can be enhanced through improved provision of services as well as exploring the new practices that have not been previously explored.

  • Reducing Expenses: any measure to cut the expenses plays a major role in increasing revenues, hence high returns. The management should watch for rising shipping costs for materials and supplies and check on payroll expenses.

  1. The total average Length of Stay

This is expressed as the ratio of the total number of patients to thetotal length of stay for all the patients. The ratio has beendecreasing consistently from 3.78 in 2007 to 3.55 in 2009. This datawas gotten from the patient data. This metric is an excellentindicator of efficiency in hospitals. A shorter ratio reflects areduction in shift care and cost per discharge from the inpatientthough they tend to be costly per day and more service intensive.This may at times result to adverse health outcomes and increasedfrequency of readmission. Therefore, in reducing the length of days,as evident in West Central Hospital, some of the measures that needto be put into place include:

  • Initiate daily bed huddles and multidisciplinary rounding: The management must ensure that the daily progress of the patients is tracked so that ancillary tasks are done on time like patient evaluation, set-up for post-acute service and payer authorizations amongst others

  • Accurate patient placement emphasis: The management must emphasize on the placement of patients within appropriate care sectors using right level, service, nursing unit, time period and right bed.

  • Manage the patient census: the elective admission of the patients should be managed well so as to stabilize the peaks in the number of patients. This also helps in balancing the patients with the number of admissions in emergency department.


  1. The West Central Hospital is doing well in:

  1. Profitability

  2. Expenses per the adjusted patient day ratios

  3. Utilization, capacity

  4. Satisfaction of patients

  1. The hospital needs to improve in:

    1. Expenses as percentage of the total operating costs

    2. Liquidity

    3. Expenses as percentage of total operating revenue

    4. Worked hours

    5. Expenses per the adjusted discharge ratios

    6. Quality outcomes

The KPIs identified reviews the performance of the hospital inrelation to its performance in the past three years. This is comparedwith the current ranking and CCG in its own CCG. The metricsidentified in the scorecard tends to over both the internal andexternal performance of the hospital, which is based on outcomes ofthe CCG. This compares quality outcomes, financial performance andsatisfaction of the patients.

Therefore, it can be concluded that, to some extent, the balancedscorecard can be rated as good. Nevertheless, there is still forimprovement. Some of this measures to improve the scorecard includethe measures being undertaken by West Central Hospital to improve itspositioning in healthcare industry. Also, the hospital should improvetheir net days in patient accounts receivable, hospital Case MixIndex and current ratio.

Aless than predicted CMI reflects a possible loss in revenue and thefailure of the West Central Hospital in capturing complications andcomorbidities as well as MCC that result into a weighted DRG that isvery high.


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