Dashboards – An Important Element for Length of Stay

A little monitoring effort can go a long way in achieving improvement.

Length of stay (LOS) continues to be examined as a metric for healthcare providers to improve. It can have positive and negative effects on both direct and indirect costs, patient care, and overhead. There is a plethora of factors that have those effects, and there needs to be a consistent methodology to monitor results and progress. Dashboards can truly serve that purpose. Is there one kind that fits all needs, however? Absolutely not!

Let’s start with a definition. We are all familiar with dashboards in our cars, and believe they are essential. According to Wikipedia, a business dashboard is a “type of graphical user interface which often provides at-a-glance views of key performance indicators relevant to a particular objective or business process. In other usage, ‘dashboard’ is another name for a progress report… and considered a form of data visualization.” We  usually see this as a table or graph or chart, sometimes in combination.

When it comes to vehicles, everyone has a dashboard, ranging from that of a snowmobile or four-wheeler, to a car, and on to the more complex, as in the Space Shuttle. Often, no one gives it a second thought; dashboards just exist and are considered part of the vehicle. As a matter of fact, they are probably taken for granted. Yet they can provide a static or moment-to-moment display of information vital to performance, changes, or trends.

If you think your vehicular dashboard offers little value, then I would suggest that you cover the entire thing and drive your car around for a couple of months that way. You’ll have to guess when it’s time to refuel, or if your engine is operating at the correct temperature. When will you know you have low tire or oil pressure? In addition, you have a speedometer to ensure you don’t get a speeding ticket. The list goes on, yet we all take the importance of the dashboard for granted. Today we have the added benefit of maps on our dashboards, with directions to get to a desired location.

Dashboards are essential for managing LOS. As with the car, a business dashboard should help you monitor important aspects of the business, but if you don’t use them, you are operating blind. Dashboards don’t have to be elaborate, and additionally, they shouldn’t monitor too many things at once. They need to keep an eye on the important factors that show how your LOS is doing during a defined period of time. Yet they need to be simple enough that everyone understands them. It can provide a snapshot for any problem, time period, and trends. It is also a great way to present ongoing process improvement to various departments and committees of your facility, such as the utilization review (UR) committee, medical executive committee, and departmental organizations. It can also serve a purpose for physician profiling.

In addition, for dashboards to be beneficial, one needs:

  • Baseline data
  • Goals – What do you want to achieve?
    • Using the old expression, if you don’t know where you are going, you won’t know when you get there – there’s a reason why a GPS works.
      • There are also different ways to get there, but you have to have a destination.
    • Goals must be SMART:
      • Specific
      • Measurable
      • Achievable
      • Reasonable
      • Time-oriented
    • Look at trends, not individual data points.
      • Use line graphs to demonstrate trends, but use percentages, not individual numbers, as there will be good and bad days.
        • Remember, 9 out of 10 is 90 percent; 91 out of 100 is 91 percent. It shows consistency. Looking at individual data points only will challenge you as to how can you see a trend if a team one day only reviews 34 cases, with three re-reviews, compared to another day when they reviewed 83 cases, with seven re-reviews required. In both cases, the review rate of cases going through the first time correctly is right around 92 percent.
      • Accentuate the positive, not the negative.
        • Do you want 0 percent rejects or 100 percent acceptance?

Every hospital and healthcare organization is going to have variable areas of LOS to review, starting from very basic to the very detailed. It is not the intention of this article to tell you what you need to review; you should know that. The below graph can be used to demonstrate what can serve as a way of defining baseline data, and direction for a process to follow.


To summarize, a dashboard is necessary to monitor a system or process. It provides the heartbeat of the organization. The team will know what is being monitored and try to accentuate the positive. Trends are being displayed.

So, what’s the negative? You have to determine what you need to monitor, and it takes a little time to record the information if you make it simple. Most importantly, the results of using a dashboard will boost your business and help manage your LOS.


John Zelem, MD, FACS

John Zelem, MD, is principal owner and chief executive officer of Streamline Solutions Consulting, Inc. providing technology-enabled, expert physician advisor services. A board-certified general surgeon with more than 26 years of clinical experience, Dr. Zelem managed quality assessment and improvement as a former executive medical director in the past. He developed expertise in compliance, contracts and regulations, utilization review, case management, client relations, physician advisor programs, and physician education. Dr. Zelem is a member of the RACmonitor editorial board.

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