Development and Implementation of a KPI-Based Management Model and Agile Governance in a Specialized Orthopedic Clinic: A Mixed-Methods Case Study

Background Specialized orthopedic clinics operate in complex environments characterized by high demand variability and multiple institutional interfaces. The absence of structured performance measurement and formal governance often leads to operational inefficiencies and financial unpredictability. This study aimed to develop and detail a management model integrating prioritized Key Performance Indicators (KPIs) and agile governance routines to optimize productivity and managerial control in a knee surgery specialized service. Methods A mixed-methods single case study was conducted in a specialized orthopedic clinic in Southern Brazil. Quantitative data on operational and financial performance (e.g., consultation volume, no-show rates, lead times, conversion rates, and Days in Accounts Receivable - AR) were analyzed. Concurrently, a qualitative assessment of organizational determinants was performed through process observation and analysis of internal documentation. Data integration was achieved through triangulation to inform the design of a customized KPI dashboard and a 90-day pilot implementation plan based on Scrum and Kanban principles. Results Baseline analysis revealed an average of 87 consultations per month, a 6% no-show rate, and a 14-day lead time for patient access. The consultation-to-surgery conversion rate was 8%, with an average of 35 Days in AR. Qualitative assessment identified bottlenecks related to partial process standardization, rework in the consultation-to-surgery transition, heterogeneous financial control (including the absence of standardized aging reports), and centralized, informal governance. The proposed model established a KPI dashboard across four strategic dimensions (Operational, Patient Experience, Clinical-Hospital Integration, and Financial-Operational) supported by iterative review cycles and structured accountability. Conclusions Integrating a parsimonious set of KPIs with agile governance routines provides a practical framework for transforming data into actionable managerial insights. This approach has the potential to reduce rework, enhance predictability, and strengthen the sustainability of specialized healthcare services by fostering continuous improvement and data-driven decision-making.