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Zolfaghari Z, Rezayatmand M, Alizadeh M, Saghaeiannejad S. Profiles for the key performance indicators (KPIs) of the hospital financial information system. jha 2025; 28 (1) :95-108
URL: http://jha.iums.ac.ir/article-1-4572-en.html
URL: http://jha.iums.ac.ir/article-1-4572-en.html
1- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2- Department of management, Isf.C. Islamic Azad University, Isfahan, Iran. & Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. ,saghaeiannejad@gmail.com
2- Department of management, Isf.C. Islamic Azad University, Isfahan, Iran. & Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
3- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. ,
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Introduction
By utilizing information generation, processing, and distribution tools, a financial information system empowers managers at various levels to monitor the information flow within their organizations and make efficient decisions based on more knowledge [1-3]. To increase the efficiency and effectiveness of financial information systems, track financial status over time, and compare current performance with the desirable states, organizations required to determine the key performance indicators (KPIs) [4-7].
When effective financial indicators are determined based on the information they provide about critical activities, resources, and expenses within the organization, organizational knowledge is increased. This, in turn, facilitate analysis of the organization’s financial status, identification of problems, and forecasting of its financial situation [4, 8,9]. To assess and determine the organization situation, it is crucial to ensure the validity of the indicators and accuracy of their estimation, enabling proper and accurate evaluations and judgments while avoiding any hasty conclusions [10,12].
Hospital financial information systems demonstrate inefficiency in real-time reporting, decision-making, and evaluation due to incomplete data, and inter-system dependencies. The implementation of a Key Performance Indicator (KPI)-based system provides a means to enhance performance, improve financial data efficiency, and increase overall service quality. Accurate KPI analysis is crucial for informed decision-making and performance improvement, facilitating the enhancement of hospital services by identifying trends and enabling benchmarking [2, 3, 7, 13, 14]. Taken the above into account, this study was conducted to formulate profiles for the KPIs of the financial information system in Farabi Hospital in Isfahan.
Methods
This applied study was performed using qualitative research method in four phases in a 350-bed specialized and sub-specialized hospital between 2021-2023.
Phase 1: Literature review
The search keywords (Key performance indicator, Key performance index, KPI, Financial information system, Finance information system, Fiscal information system, Accounting information system, Health, Hospital) were searched in relevant databases (ISI web of sciences, PubMed, ProQuest, Scopus, Google Scholar, Google search engine, Civilica, MagIran, SID, ISC) (Supplement: search strategy). Based on the inclusion criteria (relevant title, published between 2000-2023, full text availability, published in Persian or English) and exclusion criteria (absence of indicator, irrelevant content and indicator), 34 sources finally were selected after screening of 95 retrieved scientific sources.
In this phase, financial performance indicators extracted from the scientific sources were directly collected. Then, an initial profile was compiled for each indicator. in addition, duplicate indicators were removed using the prepared profile.
Phase 2: Interviews
First step: To obtain more performance indicators, a semi-structured interview was conducted with the practitioners in the financial field based on an interview guide. These practitioners were introduced by the financial office at Isfahan University of Medical Sciences. They were hospital’s manager or financial manager, with a minimum of five years of work experience. Furthermore, at the start of the interview, the researcher explained the research purpose, the interview method, and the participants’ rights to accept or refuse to take part in the study. They were also assured that the interviews would be recorded and their information would remain confidential. They were selected through a purposeful snowball sampling method. It is noteworthy that the interviews continued until data saturation. Because the last three interviews did not add any new data, the interviews were limited to 10 participants.
To ensure the validity of the findings, in addition to reviewing the findings from each interview by the research team, a list of indicators was provided to each participant to verify and confirm the performance indicators. Data were extracted using direct content analysis of the interviews. To do this, the titles of the indicators were precisely extracted from the text of each interview. After identifying all indicators from the interviews, duplicate indicators were removed. Finally, the remaining indicators were categorized.
Second step: At the end of each interview, the list of indicators identified from the first phase was provided to the participants to identify the performance indicators of higher efficiency for the health sector. The participants were asked to review the list of indicators and select those with higher efficiency.
Third step: The indicators deduced from the interview and the indicators identified from the first phase were combined and categorized. Then, the overlapping indicators were removed. To align the indicators with the strategic plan of Farabi Hospital and to verify the data inflow for each indicator, the researcher team consulted with the hospital. All indicators were found to be consistent with the goals of the hospital. However, some indicators without any informational elements/flow at the hospital were removed.
Phase 3: The expert panel
In this phase, a focused group discussion session was held with the experts using the straw poll method to determine the KPIs of the hospital financial information system. The purposeful sampling was done and the officials from Farabi Hospital, including the manager, financial manager, and accounting officer and two experts from the financial department staff at Isfahan University of Medical Sciences, including the budget performance monitoring expert and vice-president of finance were invited. The final list of indicators, collected from the previous two phases, was provided to the participants. Then, the title of each indicator was defined, and the participants were asked to express their agreement or disagreement with the assigned title. If necessary, the title of indicator was modified with the consultation and approval of the participants. After categorizing the KPIs, the list of KPIs was presented to the members of the panel for review and validation.
Phase 4: Formulating the profile
The profile of each indicator delineates its definition, calculation method, and the norm value . In this way, the definition of each indicator and its calculation method were formulated by consulting scientific sources or through conducting a structured interview with the experts.
Afterwards, to determine the norm for each KPI, the national, regional, or international standards were sought by searching valid scientific sources. However, no standard norm was found. Therefore, by pooling the opinions of the research team, the management and financial affairs team of the hospital, and the interviewees, the norm for each indicator was rated by calculating its mean score over five years, from 2017 to 2021.
To confirm the accuracy of the profile, the list of KPIs was provided to the panel of experts. After re-examination, necessary corrections were made to the list. Additionally, besides calculating the norm for the KPIs by the researchers, these norms were individually re-checked and re-approved under the supervision of the management and financial affairs team at Farabi Hospital.
Results
Phase 1 Literature review
Firstly, 368 indicators were extracted from 34 scientific sources. After categorizing the indicators and removing the duplications, 140 performance indicators were proposed and sub-classified under eight distinct categories including: liquidity, profitability, capital structure, income, cost, efficiency-asset, safety, and others.
Phase 2: Interviews
The interviews yielded 146 indicators out of which 69 duplicated indicators were removed. The majority of the indicators were related to the income and cost. In the second step, 57 financial performance indicators obtained from the literature review were omitted due to lower efficiency in the hospital, based on the viewpoint of all the participants at the end of the interviews. After merging the indicators of the first and second phases, 32 overlapping indicators were also excluded. In the third step, aligning the indicators with the strategic plan and data flow of the hospital resulted in excluding 54 additional indicators due to the lack of data availability. Finally, 74 KPIs of this phase were categorized into seven categories of income, cost, liquidity, productivity, profitability, capital structure, and efficiency-assets.
Phase 3: Expert panel
During the focus group discussion session, 36 KPIs for the financial information system were selected by the panelists. The selected indicators were categorized into three categories of income, cost, and productivity.
Phase 4: Profile of KPIs
Using the financial information of Farabi hospital retrieved from the Hospital Information System (HIS), Nezam Novin Accounting System, Kasra Accounting System, and Azarakhsh Accounting System, the mean score for each indicator over a 5-year period was estimated. These 5-year mean score represent the indicator norms. Although calculations might have limitations due to frequent changes in regulations and tariffs, analyzing trends over several years and comparing different years can still provide valuable insights for hospital financial management. The list of the Farabi hospital financial KPIs is presented in Table 1 and their profiles are provided in Supplement.
By utilizing information generation, processing, and distribution tools, a financial information system empowers managers at various levels to monitor the information flow within their organizations and make efficient decisions based on more knowledge [1-3]. To increase the efficiency and effectiveness of financial information systems, track financial status over time, and compare current performance with the desirable states, organizations required to determine the key performance indicators (KPIs) [4-7].
When effective financial indicators are determined based on the information they provide about critical activities, resources, and expenses within the organization, organizational knowledge is increased. This, in turn, facilitate analysis of the organization’s financial status, identification of problems, and forecasting of its financial situation [4, 8,9]. To assess and determine the organization situation, it is crucial to ensure the validity of the indicators and accuracy of their estimation, enabling proper and accurate evaluations and judgments while avoiding any hasty conclusions [10,12].
Hospital financial information systems demonstrate inefficiency in real-time reporting, decision-making, and evaluation due to incomplete data, and inter-system dependencies. The implementation of a Key Performance Indicator (KPI)-based system provides a means to enhance performance, improve financial data efficiency, and increase overall service quality. Accurate KPI analysis is crucial for informed decision-making and performance improvement, facilitating the enhancement of hospital services by identifying trends and enabling benchmarking [2, 3, 7, 13, 14]. Taken the above into account, this study was conducted to formulate profiles for the KPIs of the financial information system in Farabi Hospital in Isfahan.
Methods
This applied study was performed using qualitative research method in four phases in a 350-bed specialized and sub-specialized hospital between 2021-2023.
Phase 1: Literature review
The search keywords (Key performance indicator, Key performance index, KPI, Financial information system, Finance information system, Fiscal information system, Accounting information system, Health, Hospital) were searched in relevant databases (ISI web of sciences, PubMed, ProQuest, Scopus, Google Scholar, Google search engine, Civilica, MagIran, SID, ISC) (Supplement: search strategy). Based on the inclusion criteria (relevant title, published between 2000-2023, full text availability, published in Persian or English) and exclusion criteria (absence of indicator, irrelevant content and indicator), 34 sources finally were selected after screening of 95 retrieved scientific sources.
In this phase, financial performance indicators extracted from the scientific sources were directly collected. Then, an initial profile was compiled for each indicator. in addition, duplicate indicators were removed using the prepared profile.
Phase 2: Interviews
First step: To obtain more performance indicators, a semi-structured interview was conducted with the practitioners in the financial field based on an interview guide. These practitioners were introduced by the financial office at Isfahan University of Medical Sciences. They were hospital’s manager or financial manager, with a minimum of five years of work experience. Furthermore, at the start of the interview, the researcher explained the research purpose, the interview method, and the participants’ rights to accept or refuse to take part in the study. They were also assured that the interviews would be recorded and their information would remain confidential. They were selected through a purposeful snowball sampling method. It is noteworthy that the interviews continued until data saturation. Because the last three interviews did not add any new data, the interviews were limited to 10 participants.
To ensure the validity of the findings, in addition to reviewing the findings from each interview by the research team, a list of indicators was provided to each participant to verify and confirm the performance indicators. Data were extracted using direct content analysis of the interviews. To do this, the titles of the indicators were precisely extracted from the text of each interview. After identifying all indicators from the interviews, duplicate indicators were removed. Finally, the remaining indicators were categorized.
Second step: At the end of each interview, the list of indicators identified from the first phase was provided to the participants to identify the performance indicators of higher efficiency for the health sector. The participants were asked to review the list of indicators and select those with higher efficiency.
Third step: The indicators deduced from the interview and the indicators identified from the first phase were combined and categorized. Then, the overlapping indicators were removed. To align the indicators with the strategic plan of Farabi Hospital and to verify the data inflow for each indicator, the researcher team consulted with the hospital. All indicators were found to be consistent with the goals of the hospital. However, some indicators without any informational elements/flow at the hospital were removed.
Phase 3: The expert panel
In this phase, a focused group discussion session was held with the experts using the straw poll method to determine the KPIs of the hospital financial information system. The purposeful sampling was done and the officials from Farabi Hospital, including the manager, financial manager, and accounting officer and two experts from the financial department staff at Isfahan University of Medical Sciences, including the budget performance monitoring expert and vice-president of finance were invited. The final list of indicators, collected from the previous two phases, was provided to the participants. Then, the title of each indicator was defined, and the participants were asked to express their agreement or disagreement with the assigned title. If necessary, the title of indicator was modified with the consultation and approval of the participants. After categorizing the KPIs, the list of KPIs was presented to the members of the panel for review and validation.
Phase 4: Formulating the profile
The profile of each indicator delineates its definition, calculation method, and the norm value . In this way, the definition of each indicator and its calculation method were formulated by consulting scientific sources or through conducting a structured interview with the experts.
Afterwards, to determine the norm for each KPI, the national, regional, or international standards were sought by searching valid scientific sources. However, no standard norm was found. Therefore, by pooling the opinions of the research team, the management and financial affairs team of the hospital, and the interviewees, the norm for each indicator was rated by calculating its mean score over five years, from 2017 to 2021.
To confirm the accuracy of the profile, the list of KPIs was provided to the panel of experts. After re-examination, necessary corrections were made to the list. Additionally, besides calculating the norm for the KPIs by the researchers, these norms were individually re-checked and re-approved under the supervision of the management and financial affairs team at Farabi Hospital.
Results
Phase 1 Literature review
Firstly, 368 indicators were extracted from 34 scientific sources. After categorizing the indicators and removing the duplications, 140 performance indicators were proposed and sub-classified under eight distinct categories including: liquidity, profitability, capital structure, income, cost, efficiency-asset, safety, and others.
Phase 2: Interviews
The interviews yielded 146 indicators out of which 69 duplicated indicators were removed. The majority of the indicators were related to the income and cost. In the second step, 57 financial performance indicators obtained from the literature review were omitted due to lower efficiency in the hospital, based on the viewpoint of all the participants at the end of the interviews. After merging the indicators of the first and second phases, 32 overlapping indicators were also excluded. In the third step, aligning the indicators with the strategic plan and data flow of the hospital resulted in excluding 54 additional indicators due to the lack of data availability. Finally, 74 KPIs of this phase were categorized into seven categories of income, cost, liquidity, productivity, profitability, capital structure, and efficiency-assets.
Phase 3: Expert panel
During the focus group discussion session, 36 KPIs for the financial information system were selected by the panelists. The selected indicators were categorized into three categories of income, cost, and productivity.
Phase 4: Profile of KPIs
Using the financial information of Farabi hospital retrieved from the Hospital Information System (HIS), Nezam Novin Accounting System, Kasra Accounting System, and Azarakhsh Accounting System, the mean score for each indicator over a 5-year period was estimated. These 5-year mean score represent the indicator norms. Although calculations might have limitations due to frequent changes in regulations and tariffs, analyzing trends over several years and comparing different years can still provide valuable insights for hospital financial management. The list of the Farabi hospital financial KPIs is presented in Table 1 and their profiles are provided in Supplement.
Table 1. The KPIs of financial information system in use in Isfahan’s Farabi hospital
| No. | Indicator name |
| Income indicators | |
| 1 | Hospital’s total gross operating income per year |
| 2 | Hospital’s secondary deductions |
| 3 | The ratio of secondary deductions to the total net operating income (after deductions) |
| 4 | The ratio of the initial deductions to the net operating income (expressed in %) |
| 5 | The ratio of cash income to the total net income (operating and non-operating income) (expressed in %) |
| 6 | The ratio of each department’s operating income to the total net operating income |
Table 1.Continued
| No. | Indicator name |
| Income indicators(Continued) | |
| 7 | Ratio of outpatients’ income to total net operating income (expressed in %) |
| 8 | Ratio of inpatients’ income to the total net income (in %) |
| 9 | Ratio of discounts to the total operating net income (in %) |
| 10 | Professional income as a percent of total net income |
| 11 | The ratio of public donations to the total net income (in %) |
| 12 | The net income growth rate |
| 13 | The ratio of the dedicated income to the total financial resources (excluding the development budgets) |
| 14 | The ratio of undecided patients to the total operating net income (the open or fugitive cases) (in %) |
| Cost indicators | |
| 15 | The hospital’s total current costs |
| 16 | The ratio of personnel costs to total costs |
| 17 | The ratio of personnel costs covered by the hospital’s dedicated incomes to the personnel’s total costs |
| 18 | The ratio of the physician’s merit payment to the total personnel costs paid from the hospital’s dedicated incomes merit increase |
| 19 | The ratio of the overtime work costs to the total personnel costs |
| 20 | The ratio of net income to the personnel’s total cost |
| 21 | The ratio of welfare costs to the personnel’s total costs paid from the hospital’s dedicated income |
| 22 | The ratio of other personnel costs to the personnel’s total costs paid from the hospital’s dedicated income |
| 23 | The ratio of overdue receivables of the personnel and physicians separately to the total personnel costs |
| 24 | The ratio of the non-personnel costs to the total costs (All costs excluding personnel and medicine costs) |
| 25 | The ratio of hospital’s debt to medicine and equipment companies to the total expenses |
| 26 | The ratio cost of medicine and equipment to the total cost |
| 27 | The ratio of the debts to the total claims |
| 28 | The ratio of the costs of volume contracts to the total costs |
| 29 | The ratio of office supplies to the total costs |
| 30 | The ratio of energy costs to the total costs |
| 31 | The ratio of repair and maintenance costs to the total costs |
| Productivity Indicators | |
| 32 | The ratio of the number of support staff to the total hospital staff |
| 33 | The ratio of the number of medical staff to the whole number of hospital staff |
| 34 | The proportion of total number of the personnel to the total active beds |
| 35 | The ratio of resources to consumption |
| 36 | The proportion of the number of surgeries to number of beds in the surgery room |
Discussion
Making informed judgments about the hospital’s financial health is possible only when all the dimensions of financial performance are analyzed as a whole. Pink et al. [15] and Badawy et al. [16] in their studies concluded that financial performance indicators should measure the various dimensions of financial performance to facilitate planning, supervision, transparency, and decision-making support. This finding aligns with the present study. According to Johnson’s [17] study, supervision over financial outcomes and patient care quality can be traced by analyzing KPIs related to the process improvement metrics. He introduced 10 top KPIs for hospital financial management. However, only two indicators reported by Johnson [17] were in line with our final proposed indicators. The other indicators were dropped during our research process due to lower efficiency.
In one research, Abutorabi and Koohi [18] categorized hospital performance indicators under various categories including inpatients and outpatients, the human resources per active beds, the share of different hospital departments in costs, the share of outpatient and inpatient areas in hospital costs, the average costs for each hospitalized patient, and the hoteling cost (hospital stay). All the above indicators are included in the categories proposed in current research. Further, according to the expert panel, the availability and use of these indicators greatly contribute to the improvement and management of the hospital financial situation.
A financial balance sheet (encompassing both expense and revenue columns) provides valuable insights into the hospital’s financial position. Interviewees emphasized that the expense column holds particular significance for financial managers. Cost-related KPIs are, therefore, crucial for informed decision-making and accurately assessing a hospital’s financial performance. Our findings align with those of Rahimi et al. [19], whose research identified the top five key performance indicators as cost-related, including personnel costs as a percentage of total costs and the total revenue to total cost ratio.
By analyzing the financial indicators, especially income-related indicators, Alderman et al.’s [20] study played a significant role in reducing the negative effects of net income reduction, preventing increased losses, and handling financial crisis. The income indicators are perceived as important indicators because they determine and evaluate the organization’s income from different sources [20]. Similarly, in the present research, income indicators ranked second after cost indicators in terms of frequency. This, in turn, reflects the significance of using the income indicators in the analysis of hospital financial status. From this aspect, this research is in line with Alderman et al.’s study [20].
Similar to our study, Schuhmann [21] investigated the financial performance of the hospital by tracking the financial indicators and found that the income-related indicators were among the important ones although the data sources of the indicators were insurance reports. This consistency stems from the participants’ point of view on the positive role of using income indicators in detecting/tracing those hidden deductions that are not collectable from the insurance or the patient. In this regard, the indicator “the ratio of deductions to the total net income” is important. This specifies that part of the dedicated income that cannot be collected or has not been collected.
According to our study, profitability-related indicators were dropped due to lower efficiency. The only approved profitability-related KPI in terms of the expert panel was the “ratio of resources to consumption”. According to the second interviewee, analyzing profitability-related indicators can help monitor and resolve existing problems in various parts of the hospital. In contrast, other interviewees regarded most profitability indicators as impractical and even meaningless for public hospitals. Because, in comparison with private hospitals, public hospitals must provide equal services to the community members and focus on mission over profitability. Thus, considering our context, which is a public hospital, our results are incompatible with the indicators introduced by Suarez (such as the income of each shareholder) [4], Pink et al. [15], Elhuni and Monir Ahmad [22], Mirzaei et al. [23, 24], Kryukov and Strauss [25], Jannati et al. [26], and Pink et al. [27].
In a study by Mirzaei et al. [23], the identified indicators were classified into nine categories. although liquidity and capital structure related indicators were identified from literature, they were finally excluded due to lower efficiency expressed by the financial experts (interviewees). Similarly, other indicators, such as “the ratio of full-time staff to the occupied beds” were excluded due to the lack of access to the required data. Therefore, these findings contradicted those of Mirzaei et al.’s study [23].
Productivity indicators help shape the manager’s perspective regarding the quality and finance. According to the interviewees, manpower productivity indicators were among the most important ones. These indicators can influence revenue and expenses, causing a positive or negative financial balance. These indicators along with revenue and cost indicators can form a general picture of the financial situation of the hospital. For example, by using “the ratio of the total number of staff to the total number of active beds”, the number of staff members required in one section compared to the number of active beds can be determined. Two productivity indicators reported by were removed from our final list of indicators due to lower efficiency for the health domain, as perceived by the financial practitioners. Therefore, our study is inconsistent with Pink et al. study [27].
Limitations
Considering the review of literature and the inability to find an acceptable standard value for the final listed indicators, we considered the average of these indicators as the norm values to compare hospitals. It is worth mentioning that although these indicators were developed for a specific hospital, they can be adjusted for other hospitals based on their specific strategic goals.
Conclusion
The present study provides a set of KPIs for Farabi hospital financial system, which helps the hospital manager to timely monitor the financial process over a specific period and compare its performance with other hospitals or with its own previous fiscal period. Although this study found that the majority of KPIs were related to costs, comprehensive analysis of the financial situation of the hospital requires reviewing all indicators to make a reliable decision. In addition, by presenting a profile for each indicator, a shared understanding of the concept and calculation process for each indicator can be achieved. This, in turn, facilitate information exchange between experts and non-experts.
Online supplement
Search strategy
Financial KPIs with their profile
Declerations
Ethical Considerations: This research was done with the code of ethics number IR.MUI.RESEARCH.REC.1398.547 by the ethics committee of Isfahan University of Medical Sciences.
Funding: None
Conflicts of interests: None
Author’s Contribution: Zahra Zolfaghari: Conceptualization, study design, data curation, methodology, validation, data analysis, resources, data management, writing– original draft, writing–
Making informed judgments about the hospital’s financial health is possible only when all the dimensions of financial performance are analyzed as a whole. Pink et al. [15] and Badawy et al. [16] in their studies concluded that financial performance indicators should measure the various dimensions of financial performance to facilitate planning, supervision, transparency, and decision-making support. This finding aligns with the present study. According to Johnson’s [17] study, supervision over financial outcomes and patient care quality can be traced by analyzing KPIs related to the process improvement metrics. He introduced 10 top KPIs for hospital financial management. However, only two indicators reported by Johnson [17] were in line with our final proposed indicators. The other indicators were dropped during our research process due to lower efficiency.
In one research, Abutorabi and Koohi [18] categorized hospital performance indicators under various categories including inpatients and outpatients, the human resources per active beds, the share of different hospital departments in costs, the share of outpatient and inpatient areas in hospital costs, the average costs for each hospitalized patient, and the hoteling cost (hospital stay). All the above indicators are included in the categories proposed in current research. Further, according to the expert panel, the availability and use of these indicators greatly contribute to the improvement and management of the hospital financial situation.
A financial balance sheet (encompassing both expense and revenue columns) provides valuable insights into the hospital’s financial position. Interviewees emphasized that the expense column holds particular significance for financial managers. Cost-related KPIs are, therefore, crucial for informed decision-making and accurately assessing a hospital’s financial performance. Our findings align with those of Rahimi et al. [19], whose research identified the top five key performance indicators as cost-related, including personnel costs as a percentage of total costs and the total revenue to total cost ratio.
By analyzing the financial indicators, especially income-related indicators, Alderman et al.’s [20] study played a significant role in reducing the negative effects of net income reduction, preventing increased losses, and handling financial crisis. The income indicators are perceived as important indicators because they determine and evaluate the organization’s income from different sources [20]. Similarly, in the present research, income indicators ranked second after cost indicators in terms of frequency. This, in turn, reflects the significance of using the income indicators in the analysis of hospital financial status. From this aspect, this research is in line with Alderman et al.’s study [20].
Similar to our study, Schuhmann [21] investigated the financial performance of the hospital by tracking the financial indicators and found that the income-related indicators were among the important ones although the data sources of the indicators were insurance reports. This consistency stems from the participants’ point of view on the positive role of using income indicators in detecting/tracing those hidden deductions that are not collectable from the insurance or the patient. In this regard, the indicator “the ratio of deductions to the total net income” is important. This specifies that part of the dedicated income that cannot be collected or has not been collected.
According to our study, profitability-related indicators were dropped due to lower efficiency. The only approved profitability-related KPI in terms of the expert panel was the “ratio of resources to consumption”. According to the second interviewee, analyzing profitability-related indicators can help monitor and resolve existing problems in various parts of the hospital. In contrast, other interviewees regarded most profitability indicators as impractical and even meaningless for public hospitals. Because, in comparison with private hospitals, public hospitals must provide equal services to the community members and focus on mission over profitability. Thus, considering our context, which is a public hospital, our results are incompatible with the indicators introduced by Suarez (such as the income of each shareholder) [4], Pink et al. [15], Elhuni and Monir Ahmad [22], Mirzaei et al. [23, 24], Kryukov and Strauss [25], Jannati et al. [26], and Pink et al. [27].
In a study by Mirzaei et al. [23], the identified indicators were classified into nine categories. although liquidity and capital structure related indicators were identified from literature, they were finally excluded due to lower efficiency expressed by the financial experts (interviewees). Similarly, other indicators, such as “the ratio of full-time staff to the occupied beds” were excluded due to the lack of access to the required data. Therefore, these findings contradicted those of Mirzaei et al.’s study [23].
Productivity indicators help shape the manager’s perspective regarding the quality and finance. According to the interviewees, manpower productivity indicators were among the most important ones. These indicators can influence revenue and expenses, causing a positive or negative financial balance. These indicators along with revenue and cost indicators can form a general picture of the financial situation of the hospital. For example, by using “the ratio of the total number of staff to the total number of active beds”, the number of staff members required in one section compared to the number of active beds can be determined. Two productivity indicators reported by were removed from our final list of indicators due to lower efficiency for the health domain, as perceived by the financial practitioners. Therefore, our study is inconsistent with Pink et al. study [27].
Limitations
Considering the review of literature and the inability to find an acceptable standard value for the final listed indicators, we considered the average of these indicators as the norm values to compare hospitals. It is worth mentioning that although these indicators were developed for a specific hospital, they can be adjusted for other hospitals based on their specific strategic goals.
Conclusion
The present study provides a set of KPIs for Farabi hospital financial system, which helps the hospital manager to timely monitor the financial process over a specific period and compare its performance with other hospitals or with its own previous fiscal period. Although this study found that the majority of KPIs were related to costs, comprehensive analysis of the financial situation of the hospital requires reviewing all indicators to make a reliable decision. In addition, by presenting a profile for each indicator, a shared understanding of the concept and calculation process for each indicator can be achieved. This, in turn, facilitate information exchange between experts and non-experts.
Online supplement
Search strategy
Financial KPIs with their profile
Declerations
Ethical Considerations: This research was done with the code of ethics number IR.MUI.RESEARCH.REC.1398.547 by the ethics committee of Isfahan University of Medical Sciences.
Funding: None
Conflicts of interests: None
Author’s Contribution: Zahra Zolfaghari: Conceptualization, study design, data curation, methodology, validation, data analysis, resources, data management, writing– original draft, writing–
review & editing, financing; Mohammad Reza Rezayatmand: Study design, data curation, methodology, validation, data analysis, writing– review & editing, final approval; Mojtaba Alizadeh: Study design, data curation, methodology, validation, data analysis, data management, writing– review & editing, final approval; Sakineh Saghaeiannejad: Conceptualization, study design, data curation, methodology, validation, data analysis, resources, data management, writing– original draft, writing– review & editing, supervision, project administration, final approval.
Consent for publication: None
Data availability: All data is provided in the text and supplements.
AI deceleration: None
Acknowledgment: The authors would like to extend their deep gratitude to all those who have cooperated in conducting this research and promoted it by providing their valuable comments. Special thanks also go to the budget performance monitoring expert of Isfahan University of Medical Sciences and the Finance Vice-President of Isfahan University of Medical Sciences for their kind assistance. This article is a part of the thesis titled “Formulating the Profiles for the Key Performance Indicators (KPIs) of the Hospital Financial Information System”, in the master's degree, approved by the Isfahan University of Medical Sciences with code IR.MUI.RESEARCH.REC.1398.547.
Consent for publication: None
Data availability: All data is provided in the text and supplements.
AI deceleration: None
Acknowledgment: The authors would like to extend their deep gratitude to all those who have cooperated in conducting this research and promoted it by providing their valuable comments. Special thanks also go to the budget performance monitoring expert of Isfahan University of Medical Sciences and the Finance Vice-President of Isfahan University of Medical Sciences for their kind assistance. This article is a part of the thesis titled “Formulating the Profiles for the Key Performance Indicators (KPIs) of the Hospital Financial Information System”, in the master's degree, approved by the Isfahan University of Medical Sciences with code IR.MUI.RESEARCH.REC.1398.547.
Type of Study: Research |
Subject:
Health Information Technology
Received: 2025/01/6 | Accepted: 2025/08/11 | Published: 2025/09/3
Received: 2025/01/6 | Accepted: 2025/08/11 | Published: 2025/09/3
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