Kurt Salmon Associates Health Care Performance Management Guide

The health care consulting group of Kurt Salmon Associates, Inc. (KSA) provides management advisory services in
facility planning, strategy, and information technology to multi-hospital systems, community hospitals, academic
medical centers, children’s hospitals, and physician group practices. Today, the group is among North America’s most
dedicated and experienced resources to health care providers. We work closely with our clients to raise the critical questions,
explore the full range of vision and possible innovation, and develop recommendations that can be implemented.

© Copyright Kurt Salmon Associates, 2004

Foreword

HEALTH CARE ORGANIZATIONS CONTINUE TO BE BUFFETED BY A PERFECT STORM THAT IS BOTH POWERFUL IN FORCE AND 1
NATIONAL IN SCALE. This storm is a confluence of forces, including the economy, labor shortages, revenue pressures,
and industry interventions regarding demonstrable patient safety, quality, and performance.

In striving to navigate their local markets and reach their goals, health care organizations are devising and attempting
to implement various strategies, including revenue cycle management, clinical process redesign, and Six Sigma.
Drs. Robert Kaplan and David Norton of the Harvard Business School have observed that it is not necessarily bad
strategies that lead to inferior performance, but the inability to effectively deploy, communicate, monitor, and refine
those strategies.1

As organizations steer their way through dynamic and turbulent competitive environments, the corporate business plan —
a compendium of strategies, objectives, and goals — serves as the navigational chart leading them to superior performance.
The performance management system, as a business planning framework, strategy deployment tool, performance improve-
ment methodology, and measurement approach, is of growing interest throughout the industry as a means of bringing
the corporate business plan into the 21st century. Promising to transition corporate strategic planning from navigation
by the stars and whims of the wind, to a system of information technologies, automation, and the seamless flow of
information, intelligence, and best practices, performance management ensures the entire organization is working
toward a common purpose.

Many of Kurt Salmon Associates’ (KSA) clients, both in the health care and retail/consumer products industries, are
pursuing performance management initiatives to address the tactical gap between strategy definition and deployment.
The performance challenge is how best to link strategic objectives to high-performing operations.

Drs. Kaplan and Norton address this performance management limitation through the introduction of the Balanced
ScoreCard (BSC) in their seminal article and subsequent book, “The Balanced ScoreCard: Translating Strategy into Action”
(1996). The BSC is a performance management system for devising strategic objectives and translating them into a focused
set of performance measures which, in turn, focus and drive decision makers’ tactical and operational activities.

KSA considers the BSC and similar approaches, such as Management-by-Objectives (MBO), Malcolm Baldridge National
Quality Award criteria, and ISO 9000, to be performance management systems. These systems call for the development of
a corporate business plan, its communication to the workforce, and monitoring and feedback to ensure the workforce,
from CEO to staff nurse, is focused on working together in the pursuit of the business plan.

This KSA Catalyst explores the definition and application of BSC performance management systems within health care
provider organizations and considers enabling performance management information technology strategies and solutions
to help health care organizations navigate the perfect storm.

1
Kaplan, Robert S., Norton, David P “The Balanced Scorecard: Translating Strategy Into Action,” Harvard Business School Press 1996.
.,

Performance Management Systems | Navigating the Perfect Storm

Kurt Salmon Associates | Catalyst, Summer 2004

Charting the Course
Organization Performance Measurement

The theory of the BSC performance meas-

urement framework emphasizes the use of

3
average length-of-stay, in-
A CRITICAL ELEMENT OF
financial and non-financial measures in a
patient/outpatient vol-
ANY ORGANIZATION’S OVER-
ume). These traditional
ALL PERFORMANCE MAN-
balanced manner.
measurements focus man-
AGEMENT SYSTEM IS KNOW-
agement attention on past
ING WHERE THE ORGANIZA-
performance, and provide
TION IS RELATIVE TO WHERE
IT WANTS TO BE. This per- only a short-term view of
formance monitoring is achieved through the provision achieving corporate objectives. Managers hone in on the
of accurate, timely, and pertinent measurements to the previous month’s expense budget numbers, rather than
decision makers of the organization. Managers have long balancing the evaluation and performance improvement
recognized the need to measure organizational activities. of the intangible assets: effective processes, skilled and
As the management adage goes: “If you can’t measure it, satisfied human resources, and the patient care value
you can’t manage it.” However, despite this recognition, proposition necessary to maximize performance across
most health care organizations do not manage them- the four perspectives. This is analogous to steering the
selves with performance measurement systems that pro- Queen Mary II to its port of call across two oceans by
vide visibility into the full continuum of corporate activ- virtue of only a speedometer and a rear-view mirror.
ities that result in superior performance. Superior per-
The theory of the BSC performance measurement frame-
formance is achieved with the effective synthesis of four
work emphasizes the use of financial and non-financial
perspectives of corporate activities: 1) finances, 2) human
measures in a balanced manner. These measures are con-
resources, and 3) internal processes, all integrated to
nected to a cause-and-effect view of the organization’s
increase 4) the value proposition of health care delivery
activities along the four performance perspectives. The
to patients and other key stakeholders (see Figure 1).
premise is that measuring and managing the learning and
A performance management system based solely on growth of human resources and improving the effective-
measuring a single perspective, typically finances, has ness and efficiency of internal processes will lead to
limitations. Current health care performance measure- improved customer satisfaction and loyalty, which results
ments are dominated by financial reporting indicators in superior long-term financial performance.
(e.g., operating expenses, gross charges, case mix index,


FIGURE 1: BALANCED SCORECARD PERSPECTIVES

A “balanced” set of corporate performance indicators goes beyond the financial

Financial Customer
4 Economic consequences of Value proposition delivered
past actions to customer segments
Income Patient, physicians, payers, community
Expenses Customer satisfaction
Profit margin Retention
Cash flow Acquisition
Loss of sale Valued services
Strategy
Business Process Learning and Growth
Current and new internal business Infrastructure to build long-term growth
processes in which the HCO must excel and improvement
Supply chain efficiency Employee satisfaction
Achieving valued services Human resource reskilling
Effectiveness of care Information technology
Surgical infection rate Wound care training
Pathway compliance

Source: Illustrative example

This is Management Theory 101. The innovative heart of essential resource capabilities are critical to improved
the BSC approach is to explicitly select, gauge, and organ- performance of the cardiology product line? Are our
ize focused measures of the four performance perspec- patients dissatisfied with key aspects of service delivery
tives, and to deliver them to decision makers in a timely and/or medical care? Why? Each question requires an
and actionable manner via a BSC report. element of outcome measurement in the BSC. Each out-
come measurement must also be linked in an explicit
The BSC, however, is more than a scorecard of key per-
cause-and-effect relationship to the measurement of a
formance measures. To truly measure performance for
supporting process or driver that enables the achieve-
purposes of evaluation and improvement, and not just
ment of the goal (see Figure 2).
documentation, there must be a cause-and-effect connec-
tion between the business plan objectives and their oper- This outcome measurement is called a lagging indicator in
ational realization. That is, employees and managers BSC parlance, as it measures what has already happened:
must use performance measures directly related to their costs decreased, revenue increased, quality decreased.
daily tactical and operational activities — measures that The driver measurement is called a leading indicator, as it
let Operations know when to turn left, when to slow measures the capability to achieve performance in the
down, and when to stop. future: 90% of cases are being managed by a critical path-
way; 75% of case managers have received Six Sigma
Performance indicators that amount to documented
training. A scorecard that explicitly connects leading and
spilled milk (i.e., you lost $2 million in cardiology last
lagging measurements allows decision makers to take
year) do not help managers achieve corporate strategies.
action on processes that will improve desired outcomes.
Did we lose $2 million because of missed cost objectives
or revenue objectives, or both? What processes and An example: If for no other reason than habit, a cause-


FIGURE 2: BALANCED SCORECARD CAUSE-AND-EFFECT CHAINS

Learning Process Customer Finance
ome

5
Post-surgery Satisfied patients Profit margin
Outc

infection rate decreases decreases
increases
r
Drive

Wound care training Loss of sales
% of staff decreases increases


and-effect chain begins with financial outcome measures, Designing a Performance Scorecard
such as product line profitability. One way to reduce
The BSC management system is as effective when
costs and increase profitability, at least for case-based
applied to an individual line of business as when applied
reimbursement, is to reduce length-of-stay (LOS) in a
to the corporate-level business plan. To illustrate, we will
medically responsible way. The LOS lagging outcome
apply the BSC performance management system to a cor-
measure requires a leading driver measure to indicate
porate strategy to develop a cardiology center-of-excel-
how the desired LOS outcome is to be achieved. The per-
lence service line. There are two broad tasks: devising the
centage of discharges in compliance with developed crit-
service line business plan and designing the scorecard to
ical pathways could be a meaningful driver measure.
monitor and manage the performance of that business
An increased patient satisfaction score on the latest Press plan. During a planning session, management and the
Ganey survey indicates proper balance between aggres- clinical team have identified three strategic goals for the
sive case management and patient satisfaction. Have cardiology center-of-excellence:
these improvements led to greater center of excellence 1. Be recognized as the choice for cardiology cost/quality
market share, and therefore revenue stream? There should performance in the region.
be a metric in place to answer this question. Dozens of 2. Identify, target, and lead in the three “customer” seg-
permutations exist for how performance measures can ments (patient, physician, and insurance product).
relate to each other; and in turn, how the strategic objec- 3. Improve the quality and efficiency of cardiology patient
tives they represent also relate to and affect each other. clinical management.


FIGURE 3: CARDIOLOGY CENTER-OF-EXCELLENCE BALANCED SCORECARD

STRATEGIC OBJECTIVES BY PERFORMANCE MEASUREMENTS
DIMENSION LEADING DRIVER LAGGING OUTCOME
FINANCIAL PERFORMANCE
Achieve profitable growth Length-of-stay vs. best-practice benchmark Average total cost per case
6 Improve operating performance Payor contract development vs. plan Case mix adjusted occupancy rate
PROVIDER OF CHOICE
Improve hospitality of services Days to next appointment availability Customer satisfaction survey
Improve/reinforce image to customer Advertising budget per cardiac bed Marketing focus group scores
segments
INTERNAL PROCESSES
Improve clinical innovation $ in cardiology research programs Resource consumption (index vs.
Improve business productivity % of first-time clean claims benchmark)
Days in Accounts Receivable
EMPLOYER OF CHOICE
Upgrade staff competencies % of cardiology board certified physicians Strategic skill rating
Create climate for action % of staff received Six Sigma training Employee satisfaction survey


A planning team translates these goals into specific While there is no magic number of measures, research
objectives within each of the four performance perspec- supports a total of 25 to 30 performance indicators per
tives (see Figure 3). Outcome measures are then selected scorecard as ideal from a practical deployment and human
to make each objective operational by answering the sim- cognitive perspective. Measures should be accessible, rel-
ple question, “How do we know if we have achieved this evant, and easily understood. They should be balanced
objective?” Each objective is then assigned a perform- between leading and lagging performance indicators and
ance driver measurement to monitor its achievability. In short- and long-term goals. Another criterion for the
this example, each measure is also given a trend indicator measure set is balance, such that no single measure out-
to denote the desired direction, increasing or decreasing. weighs or is improved at the expense of another. The
next step in charting the achievement of the business
plan is to design and build the performance management
system that will manifest the designed scorecard.


The Shipyard
Building the Performance Management System

Performance management information

technology (PMIT) actually encompasses
Performance monitoring
AT THIS STAGE, THE CARDIAC
7
much more than the delivery of a perform- can be strategic (long-
CENTER OF EXCELLENCE
term) and operational
PERFORMANCE SCORECARD
ance scorecard. (real-time) in the type and
IS A TABLE-TOP PLANNING
EXERCISE. It is not radically timeliness of its delivered
different than dozens of measures. While manage-
planning frameworks put ment may need to under-
forth throughout the histo- stand occupancy trends to
ry of organization management science. The organization plan bed capacity and allocation for the next two years
must now determine how the performance scorecard will (strategic), it must also know this week’s census and acu-
be built and delivered to decision makers in a timely and ity to plan adequate RN coverage for next week (opera-
actionable fashion. tional). Each type of performance monitoring objective
indicates the need for different types of data sources, data
Information technology is one component of the solution.
management processes, timeliness, and analytical meth-
Performance management information technology (PMIT)
ods for delivering information and actionable knowledge
actually encompasses much more than the delivery of a
into the hands of decision makers. Certainly strategic
performance scorecard. It can enable a broader perform-
monthly, quarterly, and yearly reporting is the primary
ance management system, including the acquisition and
focus of the BSC. However, steering the organization
management of performance data, assisting with the
according to plan is only possible when measures are
business planning cycle, operational and capital budgeting,
operational and actionable as well.
Six Sigma support, and information analysis functionality.
This Catalyst will focus on a performance management EVALUATION. Performance monitoring allows manage-
system comprised of three capabilities: performance ment to identify negative and positive performance
monitoring, evaluation, and improvement. events and trends in a timely manner. Management must
then conduct root-cause analysis to drill down into layers
PERFORMANCE MONITORING. Like a radar or Doppler
of performance information detail and isolate contribut-
screen tracks a storm, effective performance monitoring
ing factors. The ability to evaluate performance indicates
explicitly maps performance measures to the business
a broader requirement for integrating and normalizing
plan’s strategic objectives, goals, and initiatives and com-
detailed performance data into a single managed per-
municates their performance to stakeholders, including
formance data resource. The data resource is made read-
Joint Commission on Accreditation of Health Care
ily available for analysis using a variety of decision sup-
Organizations (JCAHO), patients, payors, Centers for
port tools within an integrated performance management
Medicare and Medicaid Services (CMS), and the commu-
system environment. Decision makers should be able to
nity. The BSC report is the primary method of communi-
navigate seamlessly from performance monitoring to
cating to management actual vs. expected performance.
evaluation, prepared to take immediate action and make
knowledge-based decisions.


IMPROVEMENT. Once the underlying cause of a perform- BSC goal of ensuring every workforce member, depart-
ance problem is evaluated, management and analysts ment, division, and vice president knows how and
must redirect operational efforts and improve the under- how well it contributes to corporate strategy achieve-
lying process(es) to stay on the course of the business ment.
plan. The health care industry is increasingly adopting COLLABORATION FUNCTIONALITY allows accountable
Six Sigma and other performance improvement tech- management to communicate, document, and collabo-
niques and applying them to performance management rate as a team when monitoring and evaluating per-
8
systems by exploiting the performance data resource, the formance trends. There is no longer a need to play
BSC, and the collection of evaluation and analysis tools. phone tag with three department directors to explain a
More advanced capabilities include business process variance to the CEO; an organization can interact
modeling and data mining techniques that can model directly with the CEO within the environs of the per-
and explain variations and create “if-then” models for formance management system, with performance data,
improvement interventions. trends, and management explanations all in one place.

DATA MANAGEMENT. Because the goal of the BSC is to
A BROAD SET OF INFORMATION TECHNOLOGY REQUIRE-
create views of the organization that extend beyond
MENTS MUST BE MET TO ENABLE THESE THREE CAPABIL-
financial elements, data regarding clinical care, quality,
ITIES OF THE PERFORMANCE MANAGEMENT SYSTEM.
Information technology is needed to acquire performance patient safety, operations, administration, external
data, organize it for reporting and analysis, and apply benchmarks, and competitor market share are also
various visualization and analysis tools to the organized required. Data must be sourced from a wide variety of
performance data. The performance management IT internal and external information systems and data col-
components can be organized into three broad categories of lection processes. The many disparate information
functionality: the BSC, data management, and business sources — internal and external, electronic and manual
intelligence. — must be managed for the expressed purpose of per-
formance monitoring, evaluation, and improvement.
THE BSC. BSC information technology enables manage-
Data must be extracted, integrated, standardized, and
ment to visually monitor and navigate an organization’s
cleansed. The manifestation of this data management
business plan and performance measures against targets.
technology and integrated data resource effort is a corpo-
The BSC Collaborative is an organization that identifies
rate performance data warehouse.
specific BSC technology functionality and certifies vendors
against that list. Key BSC functionality includes: BUSINESS INTELLIGENCE. The management of an organi-
STRATEGY MAPPING OR VISUAL NAVIGATION of busi- zation’s performance data is one side of the coin; the
ness plan strategies, objectives, goals, and measures. tools, technologies, and methodologies to exploit that
DATA VISUALIZATION, such as performance status icons data to generate actionable knowledge is the other. A set
using stop-lighting (red, yellow, green). of what is commonly termed Business Intelligence (BI)
tools provides drill-down, Web-based reporting, statistical
DIRECTIONAL ICONS, GAUGES, DIALS, AND OTHER
VISUAL CLUES to alert management to growing prob- analysis, business activity monitoring, business process
lem areas. modeling, data mining, data visualization, portal, and
LINE-OF-SIGHT FUNCTIONALITY linking individual staff, dashboard functionality to complement and complete the
and departmental and service line performance score- PMIT environment.
cards to the corporate business plan. This serves the


Sailing the High Seas
PMIT Strategy

The strategy and solution set will depend

on the realities of the future-state vision
identify current capabili-
MUCH LIKE CLASSIC CORPO-
9
relative to the organization’s current PMIT ties’ strengths and weak-
RATE BUSINESS PLANNING,
nesses; and evaluate exist-
HEALTH CARE ORGANIZA-
environment. ing applications, skill sets,
TIONS NEED TO TAKE A CON-
tools, and processes. The
SIDERED AND STRATEGIC
assessment should identify
APPROACH TO DEFINING
the inhibitors and accelera-
AND DEPLOYING A PER-
tors to adopting a new per-
FORMANCE MANAGEMENT
formance management system and determine whether
SYSTEM AND APPLYING INFORMATION TECHNOLOGY AS A
SOLUTION. A three-step PMIT strategy process is recom- the current analytical culture and management skill set are
mended to assess where the organization is now, where able to exploit access to performance data and analytical
it wants to be, and how it will get there (see Figure 4). tools.

STEP 1: The organization assesses the existing perform- STEP 2: The next step is to define a future-state vision and
ance management system environment relative to best perform a gap analysis of the current environment.
practices and identifies corporate requirements. The goal Alternative performance management strategies for achiev-
of the assessment is to identify management require- ing the future state, assessing relative value propositions, and
ments with regard to access to performance information; recommending a preferred strategy to pursue are devised.

FIGURE 4: THREE-STEP PMIT STRATEGY PROCESS

STEP 1 STEP 2 STEP 3
(Where are we now?) (Where do we want to go?) (How do we get there?)

Examine Define Analytical Processes/ Perform Marketplace
Project Organization Culture Requirements Overview

Set Project Goals Define Analytical Evaluate
and Objectives Requirements Technology Solution(s)

Assess Current Define Data Management Select Technology
PMIT Environment Requirements Solution(s)

Identify Strengths Determine Unmet Formulate Budget and
and Weakness PMIT Needs (Gaps) Timeline Projections

Assess Define, Evaluate, and Begin PMIT
PMIT Environment Select PMIT Strategy Implementation

Source: KSA methodology


STEP 3: Upon senior leadership’s confirmation of a pre- How far can our existing financial decision support
ferred performance management strategy, it is translated applications take us in pursuing the goals of the BSC?
into a tactical plan to pursue policy changes; skill set How well does the existing information technology
development; business planning calendars; and technol- environment support the automated capture of clinical
ogy selection, acquisition, and implementation. data required for quality and patient safety perform-
ance indicators?
Performance management and assessment of the current
10 environment will undoubtedly give rise to several chal- As these probing questions indicate, the scope of a PMIT
lenges for the organization to overcome as it embarks on strategy and its associated tactical solution(s) can vary
improving its strategic planning and deployment widely. The solution may be as simple as a targeted niche
approach. These challenges include: BSC product; it may include data warehousing, budget-
Holding management accountable for performance. ing, and business planning within an ERP environment;
Enabling accountability through performance-based or it may include any solution map in between. The strat-
reward and compensation models. egy and solution set will depend on the realities of the
Affecting policy and culture changes with respect to future-state vision relative to the organization’s current
corporate information access. PMIT environment.
Building consensus and standardizing corporate per-
Upon specification of a PMIT solution scope, assessment
formance metrics across multiple perspectives, entities,
of the current PMIT environment, and identification of
and departments.
the gaps between the current environment and the
In addition to organizational behavior and cultural chal- future-state vision, the organization must determine how
lenges, a key PMIT strategy challenge is determining how best to address the gaps and move toward the future-state
best to integrate and exploit existing data and analytical vision. Based on numerous technology planning and
solutions with potentially new PMIT components and selection projects, KSA has identified three broad PMIT
solutions. strategies (see Figure 5).

Frequently asked PMIT strategy questions include: BEST-OF-BREED. Allows each entity, service line, and
Are broader requirements for data management and department to determine how best to satisfy each of the
analysis, automating the budget cycle, and integrated three PMIT components with a best-in-class solution for
business planning required, or is a visual dashboard of BSC, data management, and business intelligence.
performance indicators sufficient?
BEST-OF-FAMILY. Groups the PMIT components into
Does our Enterprise Resource Planning (ERP) vendor
“functionality families” to be addressed by a smaller set
offer a PMIT solution that can meet our health care-
of vendors, reducing cost, support, implementation, and
specific requirements?

FIGURE 5: THREE BROAD PMIT STRATEGIES

BEST-OF-BREED BEST-OF-FAMILY END-TO-END
Each PMIT component is satisfied by Group PMIT solution components into Further group PMIT solution into a single
the “best” niche vendor solution two “families” of functionality: suite of functionality: DM, BI, and BSC
Entity-/department-specific solutions – Data Management (DM) and
Business Intelligence (BI)
– The Balanced ScoreCard (BSC)

Source: KSA methodology


integration challenges. Companies should strive to stan-
PMIT VENDOR MARKETPLACE
dardize best-of-family solutions as a single PMIT solution
set across the entire organization. The definition of the
functionality families can differ based on the realities of Given the scope of an organization’s PMIT approach,
an organization’s assessment and the identified gaps in and the various possible strategies, many vendors
the PMIT environment. One definition could include data and solutions can be included in an organization’s
management and business intelligence as one family PMIT solution set. Several vendors’ business intelli- 11
(one vendor) and the BSC as another. The BSC and busi- gence and BSC products can be considered function-
ness intelligence could be yet another family coming ality families. Numerous niche vendors specialize in
from one vendor and data management technology from BSC functionality as well. While accredited by the BSC
another. Collaborative, many of these niche solutions require the
acquisition and integration of business intelligence
END-TO-END. The perceived benefits of the best-of-family
and data management tools if such don’t already
strategy can be further expanded to a strategy in which
exist. An organization lacking all three PMIT components
all the PMIT components are supplied by a single inte-
can consider a smaller set of end-to-end vendors
grated solution set from a single vendor. This strategy
claiming to offer the components in an ostensibly inte-
works best when it is deemed by the organization during
grated environment. Figure 6 provides a PMIT market-
the PMIT assessment that none of the three components
place overview based on KSA analysis. It is not an all-
— the BSC, data management, or business intelligence —
inclusive depiction of potential vendors, but repre-
are prevalent and/or enjoy a single, consistent strategy
sents perceived leadership in the PMIT space.
and solution set across the organization.

FIGURE 6: PERCEIVED PMIT LEADERSHIP

VENDOR PMIT COMPONENT BEST-OF-BREED BEST-OF-FAMILY END-TO-END

ACTIVESTRATEGY BSC

BUSINESS OBJECTS BI, DM

COGNOS BSC, DM, BI

CORVU BSC

CRYSTAL DECISION BI, BSC

HYPERION BI, BSC

INFORMATICA DM

ORACLE DM, BSC, BI

PBVIEWS BSC

SAS BI, DM, BSC

Source: KSA marketplace analysis


Compass Points

As the owner of a PMIT solution set, you will embark on the challenging voyage of deploying the policy changes,
process redesign, skill set development, and technology implementation to realize the future-state vision. Great
attention must be paid to ensuring key success factors are in place and managed within a continuous risk man-
agement program.

SECURE EXECUTIVE SPONSORSHIP. Senior management must sponsor a project of this magnitude and strategic
importance. The performance management system and PMIT must be treated as a strategic and mission-critical
initiative owned and sponsored by the CEO or his/her designee, in partnership with the CIO. This project will expose
and create numerous political challenges, require significant funding, and likely cause considerable cultural change.
Committed and astute executive sponsorship is critical to keeping the project alive, focused, and on course for success.

INVOLVE OPERATIONS. The involvement of stakeholders from operations, specifically patient care-related departments,
is also critical. The next level of performance improvement will be in patient care, quality, and clinical operations; not
finance, human resources, and materials. From strategy through implementation, stakeholders from ambulatory,
operating room, clinical, pharmacy, nursing, and senior management should be intimately involved, owning the project
and its success.

COMMUNICATE. Given the dramatic cultural change and broad scope of the project, constant and consistent com-
munication will stoke excitement and adoption of the PMIT environment. Starting with senior management, the “why
and how it will affect you” message should spread through the organization through existing communication channels,
as well as new ones, such as a performance management newsletter.

The BSC is used by more than 60% of Fortune 500 companies to measure performance and align operations with strate-
gies. Strategy is critical to guiding health care organizations through dynamic markets and ever changing competitive
environments. Outside competition, regulatory changes, and more sophisticated patient expectations are just some of
the factors driving organizational change. Only those organizations prepared to execute strategy and maximize business
performance will succeed. Performance evaluation predicated on the BSC helps integrate business and clinical perform-
ance at strategic and tactical levels by measuring, disseminating, and analyzing interrelated key performance indicators.

This Catalyst reviewed the challenges of devising and deploying an information technology strategy to enable the
goals of performance management and measurement in the stormy health care environment. Implementing PMIT
within the BSC performance management system can help align an organization’s mission, vision, and strategic plan
with its success-defining measures. Using PMIT can also create management tools to evaluate opportunities for
improvement and support knowledge-based decision making that will enable organizations to navigate successfully
into the 21st century.

We hope you found this Catalyst insightful and actionable.
For more information about how KSA can help your organization apply BSC performance management systems
and PMIT strategies and solutions to navigate the perfect storm, e-mail perform@kurtsalmon.com.

www.kur tsalmon.com
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Kurt Salmon Associates Health Care Performance Management Guide

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