Hospital dashboards and visibility of information from bedside to board

Abstract

Research widely supports the implementation of performance dashboards in healthcare settings as they yield several benefits, namely improved performance and quality of care. Despite the availability of substantial research regarding the design and implementation of performance dashboards across contexts, little is known about the extent to which performance dashboards can increase the visibility of information at different management levels within hospitals. Furthermore, research investigating whether performance dashboards can enhance data integration and communication between different hospital departments is scant. This study has shed some light on these issues. A qualitative approach in the form of an interpretivist instrumental case study was adopted for this research, and it was conducted within Malta‟s acute general hospital. Methodological triangulation was used for this study, as data were generated via two methods: observation and semi-structured interviews. Furthermore, person data triangulation was achieved during the interviews as data were collected from three groups, namely top, middle and departmental managers. The data collected from the 21 interviews were then analysed using thematic analysis. From the findings, it was evident that dashboards do enhance visibility of information as they provide management with real-time, summarised and actionable information at a glance or at the push of a button. This enhanced visibility enabled managers to achieve the expected performance improvement. Although following the implementation of dashboards there was an improvement in performance in the hospital under study, for example faster patient flow in A&E, these tools had not effectively enabled managers to improve quality in other aspects, in particular cost reductions, clinical effectiveness, patient safety and patient satisfaction. However, this study prompted active discussions at top-level management on how to make better use of hospital dashboards, thereby aiming for improvement in all the above mentioned aspects of performance. Challenges, which have been encountered during the design and implementation, have also been discussed. Although in this case study dashboards did not enhance data integration, they did enhance communication between different departments. However, it was evident that most departmental managers were still thinking of their own department‟s performance rather than that of the whole organisation. Visibility of financial metrics were also discussed both within the internal and external environment of the hospital. The former refers to the different managerial hierarchy within the hospital, while the latter mainly refers to the general public. With regard to the internal environment, there were two differing opinions. Some managers claimed that it is irrelevant for them to have visibility as they do not manage their department finances, while the other group was in favour as this may help to improve awareness regarding costs, cutting on wastage, as well as to ensure sustainability. As regards enhancing visibility of financial metrics to the public, most managers across the different groups were in favour as this creates greater awareness of problems which the hospital is facing, such as bed occupancy and wastage of pharmaceuticals. Greater visibility of performance data, both within the internal and external environment, yields several benefits as transparency of data is often correlated with quality improvement within healthcare organisations. Within the internal environment, it is crucially important as it enables managers to work towards a strategic fit between the departments that they manage and the attainment of the overall organisational goals. Furthermore, this holistic vision of the service as an organisation allows users to see whether different indicators are interdependent, as one department has an effect on the other. Transparency of information into the external environment is also important as it allows benchmarking, as well as promotes accountability, creates choices for patients and improves productivity and quality of care. Following the thorough literature review on the subject and the results of this research, various recommendations for management and for further research were proposed. Amongst which an emphasis was made on having balanced objectives within the formulation of the strategy, where other facets of improvement such as patient safety, patient satisfaction and effectiveness of care are taken into account. Another recommendation was that visibility of the overall hospital performance should be enhanced to keep different departments focused on working collaboratively in order to achieve a common goal. It is important that this acute general hospital strives to enhance visibility of performance data, both within its internal and external environment. Despite the several advantages of increasing visibility, this should be done with extreme caution and further research should be conducted since in Malta there is only one acute general hospital, and thus patients do not have many alternatives.