Experienced managers know that key performance indicators (KPIs) are benchmarks whether business activities are meeting business objectives. KPIs operationalize corporate goals by providing measurable numerical targets. They are derived from performance data and benchmarked against historical trends, best practices in the industry, or standards that reflect corporate goals. KPIs represent a set of measures that can be used in combination to determine whether the project, product line, or organization is on track to meeting goals or if and where further effort is required to drive the enterprise in the right direction. KPIs can be tracked individually or assembled into a set of indicators called a “dashboard”.

The formula for developing KPIs can be summarized as “SMART”: Specific, Measurable, Achievable, Realistic, and Time-bound. They may also be leading or lagging. Leading indicators occur in advance of the outcome and are informative about the direction that things are going, preferably in sufficient time to make corrections. Lagging, or “trailing” health indicators describe outcome and in our field are mostly related to the frequency of injury and disease.

The Table gives examples of KPIs as they might be applied to occupational health in an enterprise. KPIs can be leading or lagging. Leading indicators precede the outcome and usually reflect the process or resources available. Lagging indicators reflect the outcome and its consequences. By then, of course, it is too late and the outcome may reflect problems of the past.

Reliance on KPIs requires a commitment to the collection of data to support them. The burden should be kept to a minimum, however, however, because an elaborate and expensive system will not be sustainable. KPIs can be easily misused if they are not periodically reviewed and updated. However, updating a KPI distorts the tracking of trends unless the old and the new KPIs are both collected for a period to ensure that they are comparable or move in parallel.

Table: Examples of Key Performance Indicators in Occupational Health

Leading Indicators

1. Number of completed risk assessments for workplace hazard evaluation. (Measures activity, not quality.)
2. Percentage of “health risk assessments” completed, by business unit. (Measures completion, not just activity.)
3. Percentage of completed “health risk assessments” resulting in a recommendation that was implemented. (Measures follow-through directly and quality indirectly.)
4. Percentage of workers at-risk that have completed appropriate worker education and training programs appropriate to their positions.
5. Percentage exceeding a standard response time for medical emergencies, with documentation as to why. (Note that average response times are of virtually no interest or usefulness – it is a measure that carries essential no useful information. What matters is how many responses were inadequate as judged by a standard that reflects medical urgency.)
6. Compliance with clinical care guidelines for work-relates injuries. (Assuming that the guidelines are authoritative, such as the American College of Occupational and Environmental Medicine Practice Guidelines, this is a measure of quality of care.)
7. Number of fitness for duty evaluations performed. (Just a measure of activity but has to be known to go further.)
8. Percentage of fitness for duty evaluations with recommendations appended. (This is getting to a measure of quality.)
9. The percentage of workers who completing periodic health surveillance evaluations appropriate to their position, over cycle length
10. Number and description of health impact assessments completed for new projects
11. Time between diagnosis and reporting of work-related illness
12. Percent completeness of reporting occupational injury, comparing lowest and highest reporting levels

Lagging or Trailing Indicators

1. Sentinel event cases detected (indicative of a deeper problem)
2. Frequency of occupational illness (very hard to measure because of latency, underreporting, and appearance of many conditions after retirement)
3. Years since last fatality

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