Reflections on the process of adapting hospital performance measures for an LMIC tertiary care setup.

The hospital performance measurement is critical for any institute to identify its areas of improvement and take appropriate corrective and preventive actions. However, to design a framework that is globally acceptable has always been a challenging task. The developed countries have formulated a few models but that cannot be implemented in the developing world without understanding their context. In this paper, we are sharing our process of sifting through the numerous frameworks and models to come up with an approach that works for Indus Hospital and Health Network. We also intend to highlight the leadership thought process and challenges in coming up with and implementing our approach. Our framework is based on including volume measures to the traditional value in healthcare measures of cost-effectiveness and quality. Moreover, our measurements were done at specialty or medical condition level in various types of services offered at our hospital. We have implemented this framework in our tertiary care hospital and deem that this model has given us the liberty to design key performance indicators according to specialties, services and medical conditions being dealt in our various facilities. We hope our experience will give healthcare leaders in similar settings ideas of how best to implement hospital performance indicators based on their own circumstances.