Rethinking Healthcare KPIs: Measuring What Truly Matters for Health & Wellbeing
Healthcare is failing to keep our society healthy. Despite our best efforts, the systems we have in place are not effectively addressing the causes of poor health. The way we measure success using KPIs and Targets has become part of the problem. The Change Radar helps us better understand the problems and solutions.
Table of Contents
Why We Use Key Performance Indicators in Healthcare?
KPIs or Key Performance Indicators are used to measure a problem and determine the impact of a change or intervention. When we have a problem we want to fix we want to know if it is getting better or worse because of our actions. This is part of the scientific process. When you have a project or change you want to make setting a KPI is essential for creating a feedback loop, so that you can control the problem.
KPIs Dominate Healthcare
Our KPIs dominate healthcare whether it is waiting times, Dr appointments, numbers of hospital beds KPIS are a core part of understanding about how healthcare works. KPIs are used to create numbers that explain what is happening in healthcare and whether it is getting better or worse.
When KPIs in Healthcare Are Useful in Healthcare
Our current key performance indicators (KPIs) do a great job of tracking problems in controlled, predictable environments. The simpler the relationship between cause and effect the better. Like looking at the number beds available for operations or monitoring hospital waiting times. But when it comes to complex, human-centred issues, such as long term condition management, health behaviours, and social determinants of health these KPIs often fall short.
KPIs and the Cynefin Framework
The Cynefin Framework provides a great basis for understanding what type of problem we have. When we work in ordered and complicated systems the KPIs are helpful for us to understand the problem. But in Complex or Chaotic environments they stop providing us with a good understanding of the situation.
KPIs Fall Short on The New Shifts in Healthcare.
The government and NHS have said they want to move healthcare towards prevention, community led services, and better digital healthcare solutions. But the KPIs for these topics often don’t capture the challenges we face in these new horizons in healthcare. So we must rethink how we monitor and respond to health data.
The Limitations of Traditional Healthcare KPIs
KPIs in healthcare are typically designed for structured, cause and effect scenarios. A problem is identified, a solution is implemented, and we measure the outcome. This works well for straightforward medical conditions but is far too limited for the complex, interconnected issues people face in managing their health.
Why Traditional KPIs Fail for Complex Health Issues
- They only measure what’s easy to track. Behaviour, lifestyle, and social factors are difficult to quantify, so they are often ignored in favour of simpler, numerical targets.
- They don’t explain why problems happen. A KPI might tell you that hospital readmissions are increasing, but not whether this is due to poor post-discharge support, social isolation, or economic hardship.
- They create unintended consequences. Focusing on narrow targets can shift problems around the system rather than solving them. For example, pressure to reduce emergency admissions can lead to people being discharged too early, only to return in worse condition.
- They don’t foster learning. We want to build our learning ability so that we can better solve problems. KPIs often distance ourselves from the reality of the problem. Creating a very narrow perspective. If we just see something as a single number in the box we are limiting our ability to learn and adapt.
- They ignore the local context.Standardised targets make sense in reporting, but in the real world things are heavily affected by the environment they are in. Change is often most effective when we listen to communities and adapt to their realities. If we are not understanding and measuring the enablers of change in our communities then we risk focusing our resources on treating symptoms and not the causes.
When we focus too much on meeting narrow KPIs, we risk treating symptoms rather than causes pushing problems around the system rather than resolving them at the source.
The Change Radar: A Smarter Way to Measure & Act on Health Data
If we want to create truly effective healthcare, we need a new way of monitoring change. The Change Radar offers a way to bring together different types of data to build a more rounded understanding of people’s health.
How the Change Radar Works
1. Start with a Vision
Before collecting data, we need a clear intention of what we want to achieve. This helps us interpret data meaningfully rather than just collecting numbers for the sake of it. We can see what things matter most in our data.
2. Combine Data from Multiple Perspectives
Health is not just about hospitals and the NHS. We also need to bring together information from multiple system partners such as social workers, charities even social enterprises to get a better understanding of people from multiple perspectives. The more perspectives and the greater diversity we have the better the insight into a problem.
3. Set Triggers for Actionable Insights
We also need triggers in the data. So that we know when changes are happening. We need triggers in the data that indicate when interventions could be beneficial. These can act as learning opportunities and points of review. For example, detecting early signs of social isolation or financial strain could help prevent worsening mental and physical health.
4. We need to collect 4 sources of data:
- 🏥 Healthcare Data:
Traditional clinical indicators such as blood pressure, blood sugar levels, and hospital visits.
- 🫥 Personalised Data:
Self-reported wellbeing, wearable health tech data, and behavioural patterns.
- 🫶 Social Context:
The influence of family, friends, carers, and broader social networks on health outcomes.
- 🖼️ Environmental & Physical Factors:
How factors such as housing conditions, food availability, or alcohol accessibility shape health.
5. Two Factors to Track For Situation Awareness
i) Immediate (proximal) issues
These are thing in the immediate world of the individual Such as thing in their immediate physical or social environment as well as giving greater weight to the most recent data.
ii) Situational and future risks
These are things that are not in the immediate environment but are changes in the wider context. So for someone approaching retirement, or knowing they will have to act the primary carer for a loved one undergoing cancer treatment which may impact their mental and financial and physical wellbeing over time.
6. Mapping the Data
IT is then a good idea to map the data. This is why the change radar is a radar. The purpose of mapping is to build relationships between factors. This allows us to build an understanding of the wider environment someone is in.
By mapping these different layers of data, the Change Radar helps us anticipate and act before problems escalate. There are many ways to map, depending on data and context. In fact this can be a big part of learning. However, i do recommend Dave Snowden’s Estuarine Mapping as an excellent way of building strategy from maps.
7. Qualitative Data Reporting
The data is also to be connected by information and self reports about the person or people affected. The idea is to connect data with meaning, so that we can better understand the situation. This aligns with Nora Bateson’s concept of ‘Warm Data’
Beyond KPIs: A More Dynamic Approach to Health & Wellbeing
The Change Radar is not about replacing KPIs but supplementing them with a richer, more adaptive way of measuring and responding to health challenges.
It can be used:
✅ At the start of a project to identify what the real problems are.
✅ Throughout the process to monitor change and adjust interventions in real time.
✅ At the end of a project to evaluate the effectiveness and ensure lasting impact.
Surely This is a Lot of Data Collection?
Not necessarily with the new AI and digital tools we can collect the data ‘ambiently’. Meaning we can automate much of this data collection making it invisible.For example by automatically collecting data through someone’s watch or phone. Allowing us to measure and act smarter without adding extra burden to patients and frontline staff.
Conclusion A Healthier Future: Measuring Change That Matters
If we are to truly transform healthcare, we need to shift from a reactive, KPI driven system to a proactive, intelligence led approach. The Change Radar gives us the ability to see patterns, understand context, and respond with precision. This helps people to better manage long-term conditions, tackle health inequalities, and embrace preventative care.
To create a healthier society, we need to measure what matters and the Change Radar offers a smarter, more human-centred way forward of integrating data and understanding problems.
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