Evaluating the Strength of the Evidence Part 3 – Evidence fr…

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Identifying and Strengthening the Evidence Essay Part 3

Key performance indicator (KPI) evidence from within my organization and among stakeholders.

Whereas part 2 of this activity focused on scientific evidence and practitioner articles, Part 3 considers evidence from my organization and stakeholders. Evidence-based management asks leaders to consider scientific data along with internal organizational information, professional expertise, and stakeholder values (Barends & Rousseau, 2018). This requires carefully examining available performance records and talking with staff members about their thoughts and beliefs.

Key performance indicator (KPI) data used in my chosen mid-sized outpatient setting falls into three general categories: quality/performance records, HR metrics, and patient satisfaction data. The organization tracks and reports metrics on patient wait times, no-show appointments, patient survey scores, staff productivity, throughput, and some financial indicators like revenue per visit and cost per encounter. Dashboards are pulled from the electronic health record reporting system on a monthly basis and reviewed in leadership meetings. These dashboards usually focus on key operational metrics such as time-to-provider, length of visit, and same-day access rates. Dashboard use has been shown to improve knowledge of operational performance (Coiera et al., 2025), but performance improvements were only noted when leaders took action to correct problems rather than simply reviewing dashboards.

HR metrics are collected on employee turnover, absenteeism, and staff engagement metrics captured through annual employee climate surveys. Employee turnover has an impact on patient access and flow throughout the organization, so HR metrics can be tied to operational performance. Although HR metrics are tracked alongside performance indicators, they are not often interpreted together. Decision-making based on siloed data limits leaders ability to make cross-functional improvement. De Melo Santos et al. (2025) found that performance measurement systems are strengthened when indicators are linked to one another instead of assessed independently. In the current organization, separated reporting channels may weaken any related evidence.

Patient satisfaction surveys represent another source of performance data used in the organization. Patient surveys are conducted quarterly and contain both numerical ratings and open-text comments. Leaders use numerical ratings as benchmarks for performance improvement, but comments are used to drive responses to patients. Occasionally, individual comments are brought to a department heads attention, despite trending stable satisfaction scores.

Leadership perceptions provide additional insight when examining how evidence is used. When talking with leaders and staff members informally, I learned that leaders viewed KPIs as an important component of accountability, payer requirements, and regulatory obligations. Managers found dashboard reporting helpful for understanding trends in wait times and productivity gaps. Some staff members including front-line providers and support staff view productivity metrics (e.g., visits per day) as a reductive measure of care.

Ethical implications exist when using KPI data to drive decisions as well. Leaders should consider potential harm to patients or employees when acting on KPIs. Failing to adjust productivity measures for patient acuity may pressure teams to shorten patient encounters. Ethical leaders balance efficiency with providing quality care, maintaining patient safety, and enhancing the patient experience. Patient health information used to report KPIs is also subject to HIPPA standards. Leaders should consider ethical and legal requirements when using employee performance data for decision-making. Transparency and information sharing can help maintain trust among staff members.

Evidence-based management requires leaders to not only identify the strength of evidence but weigh ethical concerns as well (Barends & Rousseau, 2018). Stakeholder interpretations of KPI data can also strengthen or weaken the available evidence.

In conclusion, the strength of evidence internally would be considered moderate. Much of the quantitative data used for decision-making is collected through the EHR system and is reliable. However, there are gaps in internal systems that weaken the strength of the evidence. Not all indicators are defined consistently across departments which weakens comparison. Qualitative data such as staff and patient input is anecdotal and not collected through formal focus groups or validated surveys. Finally, financial, HR, and operations metrics are not linked during reporting periods which reduces leaders ability to integrate and view organizational performance holistically.

Nabovati et al. (2023) reported that hospital managers utilize a subset of key performance indicators when making decisions based on information needs. Common KPIs included wait times, patient satisfaction scores, financial indicators, and safety metrics. In alignment with this research, leaders in my organization focus on wait times, patient satisfaction scores, and productivity when discussing performance improvements during meetings. These areas strengthen the relevance of KPIs used in the organization, but they may limit visibility on long-term improvements.

Combining scientific evidence from Part 2 with internal organizational information and stakeholder perceptions, leaders should continue to use KPI data to identify areas of organizational performance. However, careful attention should be paid to how dashboards are used and how productivity impacts quality of care. To strengthen internal evidence, organizations should link HR, operations, and financial metrics; create formalized methods for stakeholder feedback; and investigate how productivity metrics relate to quality of care.

References

Barends, E., & Rousseau, D. M. (2018). Evidence-based management: How to use evidence to make better organizational decisions . Kogan Page Publishers.

Coiera, E., Chan, A., Brooke-Cowden, K., Rahimi-Ardabili, H., Halim, N., & Tufanaru, C. (2025). Clinical and economic impact of digital dashboards on hospital inpatient care: A systematic review. JAMIA Open , 8 (4), ooaf078. https://doi.org/10.1093/jamiaopen/ooaf078

de Melo Santos, C. J., Barbosa, A. S., & Oliveira SantAnna, . M. (2025). Performance measurement systems in primary health care: A systematic literature review. BMC Health Services Research , 25 , 353. https://doi.org/10.1186/s12913-025-12412-6

Nabovati, E., Farrahi, R., Sadeqi Jabali, M., Khajouei, R., & Abbasi, R. (2023). Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers. Health Informatics Journal , 29 (4), 14604582231221139. https://doi.org/10.1177/14604582231221139

Smith, M., & Bititci, U. (2022). Interactions between performance measurement and management, employee engagement and performance. International Journal of Operations & Production Management , 42 (3), 255276.