Technological advancements and the use of key performance indicators in hospital management: a critical-conceptual review

Despite extensive critiques of key performance indicator (KPI)-based performance measurement and rapid advances in digital health technologies, limited research has examined how such technological and data capabilities intersect with the fundamental limitations of hospital KPIs. This study addresses this gap through a critical-conceptual review that synthesizes the literature on hospital performance measurement and healthcare technology. Focusing on the main critiques of KPIs across six major categories of hospital performance, financial performance, timeliness of care and access, patient experience, quality of care and patient safety, workforce-related performance, and resource utilization and operational efficiency, the review analyzes how technological advancements influence the use of commonly applied hospital and emergency department KPIs. The paper discusses that technological and data-related advancements consistently mitigate technical constraints on KPI use by improving data completeness, timeliness, and system integration. However, these improvements do not resolve the core limitations of KPI-based performance frameworks. Across the main critiques of KPIs, enhanced technologies are shown not to resolve all limitations and may even intensify problems related to metric dominance, inequitable benchmarking, and performance paradoxes. Overall, the review demonstrates that technology, as a standalone intervention, does not improve hospital performance. By conceptually linking established KPI critiques with technological advancements across performance domains, this study closes an important gap in the literature. The review furthermore provides a structured foundation for future research and managerial decision-making on value-driven hospital performance measurement.