Strategic alignment of emergency department key performance indicators with Saudi Vision 2030 healthcare transformation cornerstones: an expert-rated policy mapping study

Imagine the healthcare system as a massive, bustling city. In this city, the Emergency Department (ED) is the main train station. It's where everyone arrives when they are in a hurry, sick, or hurt. For a long time, the people running the station only cared about one thing: how fast they could get passengers through the turnstiles and onto the trains. They counted how many people walked in, how long they waited for a ticket, and how quickly they left. This is called "throughput." It's important because if the station gets too crowded, people get hurt, and the whole city grinds to a halt.

But recently, the city leaders decided they wanted a better plan for the future, called "Vision 2030." They realized that just moving people fast isn't enough. They wanted to know: Are we keeping people healthy before they even get sick? Are we treating our station workers well so they don't burn out? Are we using our fuel and money wisely? And are we actually making the city safer for everyone in the long run? These are the four big goals, or "cornerstones," of the new plan. The big question for this study was: Are the station managers actually measuring these new goals, or are they still just staring at the stopwatch?

This paper is like a detective story where a researcher, Loui Kamel Alsulimani, went on a mission to check the scorecards of Saudi Arabia's Emergency Departments. He gathered a huge list of 176 different things that hospitals might be measuring, from "how long a patient waits" to "how many staff members are on break." After cleaning up the list and removing duplicates, he was left with 86 unique "Key Performance Indicators" (KPIs)—basically, the report cards hospitals use to grade themselves.

He then brought in a team of experts to play a matching game. They took each of the 86 indicators and asked: "Does this measure our goal of Better Health? Does it measure Better Care? Better Sustainability (using resources wisely)? Or Better Workforce (taking care of the staff)?" They rated each one on a scale: 0 (no connection), 1 (sort of connected), or 2 (directly connected).

The results were a bit surprising, like finding out your favorite video game only tracks your speed but ignores your score. The study found that the Emergency Departments are incredibly good at measuring "Better Care." In fact, 91.9% of the indicators (79 out of 86) were directly aligned with getting patients through the door and treating them quickly. The experts were very sure about this, with high agreement on these ratings.

However, when it came to the other three goals, the scorecards were almost empty.

• Better Health (preventing sickness and helping the whole community) was the biggest gap. Only 18.6% of the indicators (16 out of 86) were directly linked to this. In fact, nearly one-third of the indicators had no connection to population health at all.
• Better Workforce (making sure doctors and nurses aren't exhausted and are well-trained) was also underrepresented, with only 43.0% of indicators directly aligned. The experts even struggled to agree on how to rate these, suggesting that we don't have clear rules for measuring staff well-being yet.
• Better Sustainability (using money and resources wisely) was in the middle, with 55.8% alignment, but still far behind the focus on speed.

The paper suggests that while the current system is excellent at keeping the train station moving fast and safely, it is missing the bigger picture. It's like a race car driver who is amazing at hitting the gas pedal but has no idea how much fuel they are burning or if the engine is overheating. The study argues that we don't need to stop measuring speed—because that is still vital for safety—but we need to add new gauges to the dashboard. We need to start measuring how well we prevent illness, how we treat our staff, and how we save resources, so that the Emergency Department can truly help build the healthier, smarter future that the national vision promises.