This document provides an overview of implementing a balanced scorecard approach for small rural hospitals. It discusses modifying the balanced scorecard to better fit the needs of rural hospitals with limited resources. The key components discussed are conducting a readiness assessment, educating leadership and stakeholders, identifying relevant data and benchmarks, and gaining commitment from hospital administration for long-term use. The goal is to develop a balanced scorecard that translates a rural hospital's strategy into meaningful performance measures across financial, customer, internal process, and learning/growth perspectives.
The Balanced Scorecard was introduced in 1992 as a performance measurement framework that monitors an organization's performance toward strategic goals. It gives managers a comprehensive view across financial, customer, internal process, and learning & growth perspectives. The document then provides examples of how Philips, Unified CallSoft, and Zenith Systems implemented Balanced Scorecards to address various issues and improve performance alignment, transparency, and strategic focus.
The document outlines a simple balanced scorecard approach developed by Samurai for managers. It discusses establishing a mission, vision, and strategy, then mapping these out on a single page. Key steps include preparing a 1-page summary, communicating it via a 1-slide presentation, and executing the plan on a single page. The balanced scorecard is intended as a management tool to be used in meetings to check measures, achievement, and trends and agree on actions.
The document discusses using a balanced scorecard and strategy map to drive corporate performance. It provides an overview of key components:
1) A balanced scorecard balances financial and non-financial metrics across four perspectives: financial, customer, internal processes, and learning and growth.
2) A strategy map translates a company's strategy and helps identify strategic objectives and key performance indicators (KPIs) within each perspective.
3) KPIs should be measurable, relevant to objectives, and help evaluate progress towards strategic goals. Different types of KPIs include productivity, quality, profitability and more.
The document discusses implementing a balanced scorecard approach at a client's firm. It describes challenges the client previously faced around strategy execution and measurement. It then details the goals sought in implementing a balanced scorecard, including aligning operations with strategy and facilitating strategic learning. Lessons learned from the client's implementation included establishing cause-and-effect linkages between objectives and ensuring balance between leading and lagging indicators.
This document discusses organization change management (OCM) and its importance for project success. OCM is a systematic process that mitigates risks and leverages change through activities like stakeholder engagement, communications planning, training development, and assessing business readiness. It produces deliverables such as stakeholder management plans, communications schedules, and training needs assessments. The level of OCM effort depends on the project's scope, timeline, criticality and complexity. OCM is a leadership accountability area critical to driving business value from projects by managing organizational impacts and changes.
BSC one of the most amazing strategy tools I ever worked with. I am sure this topic been discussed many times but I try to explain it from my point of view
Strategic Workforce Planning Model Powerpoint Presentation SlidesSlideTeam
“You can download this product from SlideTeam.net”
Our content-ready strategic workforce planning PowerPoint presentation has pre-designed templates that provide fact-based methods of understanding workforce behavior. This human resource management PPT presentation contain varied range of PowerPoint templates on organizational development, employee plan, vision mission and values, goals and objectives, performance requirements, core skills and competencies, industry trends external analysis, labor market forecast, demographic makeup of customers, human resource trends, levels of employee performance, current staff composition, managing future workforce needs, gap analysis, gap closing strategies, and employee action management. Our workforce developments strategies framework PowerPoint template can impress your viewers and leave an impact on your audiences. Create the impact you wish to deserve. Download our impressive human capital presentation design for topics like succession planning, workforce management, staffing and personnel, human resource management, human capital, capacity building, workload analysis, supply and demand forecasting and business transformation. This strategic workforce planning model PPT slides can make your presentation look even more impressive. Give off confidence with our Strategic Workforce Planning Model Powerpoint Presentation Slides. Display an attitude of self assurance. https://bit.ly/3ETrVdj
I've often been charged with business process review and creation, so over time I've developed checklist that highlights the main areas that I want to assess when working on a process analysis project.
The Balanced Scorecard was introduced in 1992 as a performance measurement framework that monitors an organization's performance toward strategic goals. It gives managers a comprehensive view across financial, customer, internal process, and learning & growth perspectives. The document then provides examples of how Philips, Unified CallSoft, and Zenith Systems implemented Balanced Scorecards to address various issues and improve performance alignment, transparency, and strategic focus.
The document outlines a simple balanced scorecard approach developed by Samurai for managers. It discusses establishing a mission, vision, and strategy, then mapping these out on a single page. Key steps include preparing a 1-page summary, communicating it via a 1-slide presentation, and executing the plan on a single page. The balanced scorecard is intended as a management tool to be used in meetings to check measures, achievement, and trends and agree on actions.
The document discusses using a balanced scorecard and strategy map to drive corporate performance. It provides an overview of key components:
1) A balanced scorecard balances financial and non-financial metrics across four perspectives: financial, customer, internal processes, and learning and growth.
2) A strategy map translates a company's strategy and helps identify strategic objectives and key performance indicators (KPIs) within each perspective.
3) KPIs should be measurable, relevant to objectives, and help evaluate progress towards strategic goals. Different types of KPIs include productivity, quality, profitability and more.
The document discusses implementing a balanced scorecard approach at a client's firm. It describes challenges the client previously faced around strategy execution and measurement. It then details the goals sought in implementing a balanced scorecard, including aligning operations with strategy and facilitating strategic learning. Lessons learned from the client's implementation included establishing cause-and-effect linkages between objectives and ensuring balance between leading and lagging indicators.
This document discusses organization change management (OCM) and its importance for project success. OCM is a systematic process that mitigates risks and leverages change through activities like stakeholder engagement, communications planning, training development, and assessing business readiness. It produces deliverables such as stakeholder management plans, communications schedules, and training needs assessments. The level of OCM effort depends on the project's scope, timeline, criticality and complexity. OCM is a leadership accountability area critical to driving business value from projects by managing organizational impacts and changes.
BSC one of the most amazing strategy tools I ever worked with. I am sure this topic been discussed many times but I try to explain it from my point of view
Strategic Workforce Planning Model Powerpoint Presentation SlidesSlideTeam
“You can download this product from SlideTeam.net”
Our content-ready strategic workforce planning PowerPoint presentation has pre-designed templates that provide fact-based methods of understanding workforce behavior. This human resource management PPT presentation contain varied range of PowerPoint templates on organizational development, employee plan, vision mission and values, goals and objectives, performance requirements, core skills and competencies, industry trends external analysis, labor market forecast, demographic makeup of customers, human resource trends, levels of employee performance, current staff composition, managing future workforce needs, gap analysis, gap closing strategies, and employee action management. Our workforce developments strategies framework PowerPoint template can impress your viewers and leave an impact on your audiences. Create the impact you wish to deserve. Download our impressive human capital presentation design for topics like succession planning, workforce management, staffing and personnel, human resource management, human capital, capacity building, workload analysis, supply and demand forecasting and business transformation. This strategic workforce planning model PPT slides can make your presentation look even more impressive. Give off confidence with our Strategic Workforce Planning Model Powerpoint Presentation Slides. Display an attitude of self assurance. https://bit.ly/3ETrVdj
I've often been charged with business process review and creation, so over time I've developed checklist that highlights the main areas that I want to assess when working on a process analysis project.
The document discusses the Balanced Scorecard (BSC) management strategy. It begins with an introduction to BSC, created by Kaplan and Norton in the 1990s. The document then covers [1] the purpose and benefits of BSC in setting goals and measuring performance across financial, customer, internal process, and learning/growth perspectives; [2] the philosophy of having employees who create performance also measure it; and [3] the principles of aligning BSC with an organization's strategy. It provides steps for developing a BSC including assessing values, planning strategy, setting objectives/measures/targets, creating a strategy map, defining initiatives, and automating the system. Finally, it discusses Vietnam-based DHG
Balanced scorecard and policy deploymentRamesh P.R.
Greetings from Seven Steps!
As another April is around the corner, we are sure that you are busy with the ambitious plans and goals for the next year. As you may agree, one of the biggest challenge for any organization is the gap in the execution of this strategies and plans.
A Study Says 9 of 10 Companies Fail to Execute Strategy .
Companies are struggling hard to align individual’s goals and execution plans in line with the organizational goals. Seven Steps Academy of Excellence developed a unique and powerful experiential learning programme to help the organizations in achieving their Business and Operational goals . More than 30 organizations enjoying the benefits of this programme
Welcome to the 2 day Experiential Learning Program on
“Effective Goal deployment using Balance Score Card and Policy Deployment Tools”
The document discusses the balanced scorecard framework. It explains that a balanced scorecard translates an organization's mission and strategy into comprehensive performance measures across four perspectives: financial, customer, internal business processes, and learning and growth. This provides managers with a framework to implement strategy and navigate future success. Key metrics are balanced between outcomes and drivers of future performance. The balanced scorecard also emphasizes linking strategic objectives and measures, communicating strategy, and facilitating strategic feedback and learning.
Performance review training for managersHelen Joseph
Great managers aren’t born; they’re made. Many new managers need help communicating effectively with employees, giving feedback and taking on a leadership role.
Performance management training always focuses on teaching managers how to accomplish or facilitate work through others, and how to direct and develop their employees.
The document provides an overview of a workshop on strategic planning. It explains the strategic planning process and model that will be used, which includes an environmental scan, assessment, setting mission, vision, goals and objectives, performance measures, and evaluating progress through a balanced scorecard. The strategic planning model outlines the key components and ensures the entire organization is aligned in executing the strategic plan.
The document discusses various business process improvement (BPI) tools and techniques that can be used to analyze, measure, and enhance business processes. It describes tools like process modeling, check sheets, surveys, interviews, brainstorming, and the nominal group technique. Process improvement aims to reduce costs, improve efficiency, enhance quality, and reduce cycle times through methods for analyzing "as-is" processes, defining opportunities, and designing improved "to-be" processes.
This document introduces Key Performance Indicators (KPIs) and provides details about how to establish an effective KPI system. It defines KPIs as metrics used to evaluate factors crucial for organizational success. It also describes performance plans that outline expectations and appraisals that provide feedback. Additionally, it notes that KPIs and appraisals are tied to rewards and consequences for individuals and inform organizational planning. The document recommends setting clear, measurable targets and encouraging communication to improve appraisal effectiveness and employee satisfaction. Finally, it provides an example of how to establish KPIs at different levels of an organization to meet overall business objectives.
Performance Management Training Presentationjwatson1191
The document discusses performance management and reviews at Leader Dogs for the Blind. It provides objectives for a training session which include improving communication, conducting annual reviews, managing problem performance, and stimulating high performers. Key aspects of performance reviews covered are establishing SMART goals, conducting objective annual reviews, addressing performance issues, and the importance of documentation. The overall goal is to increase job satisfaction through fair and constructive performance management.
The document discusses process mapping techniques to analyze a company's current ("As-Is") processes and design improved future ("To-Be") processes. It covers identifying process steps, mapping workflows, analyzing inefficiencies, defining metrics, and implementing improvements through a Plan-Do-Study-Act cycle. The goal is to understand processes, find opportunities for streamlining, and establish a shared understanding of work across departments.
Performance management is an ongoing process that aligns employee performance with business goals. It has four key steps: defining goals, planning performance, coaching performance, and reviewing performance. Effective performance management provides employees with direction, benchmarks progress, and builds confidence. Regular feedback is important to motivate employees and address any issues. Formal annual reviews measure what employees have achieved against their goals and assess their behavior and development needs. The goal is to both develop and motivate high performers, as well as address issues with poor performers.
Gartner analysts will discuss latest BPM trends at the Gartner Business Process Summit 2011, 7-8 March in London. For further information about the event please visit europe.gartner.com
This document discusses key performance indicators (KPIs) for senior account executives. It provides examples of KPIs, steps for creating KPIs, common mistakes to avoid, and how to design effective KPIs. The document recommends visiting an online site for additional KPI samples and materials related to performance appraisals, review phrases, and interview questions.
The balanced scorecard is a performance measurement framework that was created to address the shortcomings of solely using financial metrics to measure performance. It complements traditional financial measures with non-financial measures covering four perspectives: customer, internal business processes, learning and growth, and financial. The balanced scorecard is used by translating the organization's vision into objectives and measures across the four perspectives, communicating and linking strategic goals throughout the organization, incorporating strategic planning into the budgeting process, and providing feedback to continuously improve strategic performance and change. Many organizations across industries have adopted the balanced scorecard framework.
The document discusses the Balanced Scorecard methodology created by Kaplan and Norton. It presents the four perspectives of the Balanced Scorecard - financial, customer, internal process, and learning and growth. For each perspective, objectives, key performance indicators, targets, and initiatives are identified. The methodology balances both financial and non-financial measures across short and long term goals. It provides a framework for translating an organization's mission and strategy into tangible objectives and measures.
Performance Evaluation PowerPoint PPT Content Modern SampleAndrew Schwartz
136 slides include: 4 benefits and 11 additional values of performance appraisals, performance interviews, ground rules for performance evaluation, building performance contracts, developing work plans, setting the stage for a performance appraisal meeting, opening and closing your appraisal session, handling poor performance, conducting a feedback meeting, how to conduct a performance appraisal discussion, how to's and more.
There's plenty of questions surrounding KPIs and Metrics. What is a KPI? What are KPIs used for? How do I develop KPIs? Who determines KPIs? How do I create a KPI? Which KPIs should I use? When should I use a KPI? Why should I review KPIs? How do I report on KPIs? Which companies use KPIs? KPIs vs Metrics vs Measures vs OKRs? This guide aims to answer all of that and give you resources for more information!
Succession planning involves systematically developing a pipeline of internal talent to fill critical leadership roles when vacancies occur. It aims to identify the best candidates for each position and concentrate resources on developing high-potential employees. An effective succession planning process identifies key roles, assesses current and future competencies needed, evaluates talent, identifies competency gaps, and establishes development plans to fill those gaps. This helps ensure leadership continuity, retain top talent, and prepare new leaders for their roles.
The balanced scorecard is a strategic performance management tool that allows managers to track execution of activities and monitor consequences. It was created by Kaplan and Norton to provide a balanced view of organizational performance across four perspectives: financial, customer, internal business processes, and learning and growth. The balanced scorecard translates an organization's vision and strategy into objectives and measures across these four perspectives, allowing managers to monitor performance and make informed strategic decisions. It has benefits like improved strategy communication and execution, better performance reporting, and better organizational alignment. Many major companies worldwide use the balanced scorecard approach to manage performance.
Health Informatics Journal - Balanced ScorecardJulius Veracion
The document summarizes the design and evaluation of a balanced scorecard for the health information management department at a large urban hospital in Canada. The creation of the balanced scorecard involved 6 months of planning, development, implementation, and evaluation. Key steps included aligning the scorecard with the hospital's strategy, identifying relevant metrics, gathering staff input, and conducting an evaluation survey. The majority of health information management staff agreed that the balanced scorecard is a useful reporting and management tool, supporting the success of developing it for the department. The process used to identify metrics can help other health information management departments create their own balanced scorecards.
The document discusses the Balanced Scorecard (BSC) management strategy. It begins with an introduction to BSC, created by Kaplan and Norton in the 1990s. The document then covers [1] the purpose and benefits of BSC in setting goals and measuring performance across financial, customer, internal process, and learning/growth perspectives; [2] the philosophy of having employees who create performance also measure it; and [3] the principles of aligning BSC with an organization's strategy. It provides steps for developing a BSC including assessing values, planning strategy, setting objectives/measures/targets, creating a strategy map, defining initiatives, and automating the system. Finally, it discusses Vietnam-based DHG
Balanced scorecard and policy deploymentRamesh P.R.
Greetings from Seven Steps!
As another April is around the corner, we are sure that you are busy with the ambitious plans and goals for the next year. As you may agree, one of the biggest challenge for any organization is the gap in the execution of this strategies and plans.
A Study Says 9 of 10 Companies Fail to Execute Strategy .
Companies are struggling hard to align individual’s goals and execution plans in line with the organizational goals. Seven Steps Academy of Excellence developed a unique and powerful experiential learning programme to help the organizations in achieving their Business and Operational goals . More than 30 organizations enjoying the benefits of this programme
Welcome to the 2 day Experiential Learning Program on
“Effective Goal deployment using Balance Score Card and Policy Deployment Tools”
The document discusses the balanced scorecard framework. It explains that a balanced scorecard translates an organization's mission and strategy into comprehensive performance measures across four perspectives: financial, customer, internal business processes, and learning and growth. This provides managers with a framework to implement strategy and navigate future success. Key metrics are balanced between outcomes and drivers of future performance. The balanced scorecard also emphasizes linking strategic objectives and measures, communicating strategy, and facilitating strategic feedback and learning.
Performance review training for managersHelen Joseph
Great managers aren’t born; they’re made. Many new managers need help communicating effectively with employees, giving feedback and taking on a leadership role.
Performance management training always focuses on teaching managers how to accomplish or facilitate work through others, and how to direct and develop their employees.
The document provides an overview of a workshop on strategic planning. It explains the strategic planning process and model that will be used, which includes an environmental scan, assessment, setting mission, vision, goals and objectives, performance measures, and evaluating progress through a balanced scorecard. The strategic planning model outlines the key components and ensures the entire organization is aligned in executing the strategic plan.
The document discusses various business process improvement (BPI) tools and techniques that can be used to analyze, measure, and enhance business processes. It describes tools like process modeling, check sheets, surveys, interviews, brainstorming, and the nominal group technique. Process improvement aims to reduce costs, improve efficiency, enhance quality, and reduce cycle times through methods for analyzing "as-is" processes, defining opportunities, and designing improved "to-be" processes.
This document introduces Key Performance Indicators (KPIs) and provides details about how to establish an effective KPI system. It defines KPIs as metrics used to evaluate factors crucial for organizational success. It also describes performance plans that outline expectations and appraisals that provide feedback. Additionally, it notes that KPIs and appraisals are tied to rewards and consequences for individuals and inform organizational planning. The document recommends setting clear, measurable targets and encouraging communication to improve appraisal effectiveness and employee satisfaction. Finally, it provides an example of how to establish KPIs at different levels of an organization to meet overall business objectives.
Performance Management Training Presentationjwatson1191
The document discusses performance management and reviews at Leader Dogs for the Blind. It provides objectives for a training session which include improving communication, conducting annual reviews, managing problem performance, and stimulating high performers. Key aspects of performance reviews covered are establishing SMART goals, conducting objective annual reviews, addressing performance issues, and the importance of documentation. The overall goal is to increase job satisfaction through fair and constructive performance management.
The document discusses process mapping techniques to analyze a company's current ("As-Is") processes and design improved future ("To-Be") processes. It covers identifying process steps, mapping workflows, analyzing inefficiencies, defining metrics, and implementing improvements through a Plan-Do-Study-Act cycle. The goal is to understand processes, find opportunities for streamlining, and establish a shared understanding of work across departments.
Performance management is an ongoing process that aligns employee performance with business goals. It has four key steps: defining goals, planning performance, coaching performance, and reviewing performance. Effective performance management provides employees with direction, benchmarks progress, and builds confidence. Regular feedback is important to motivate employees and address any issues. Formal annual reviews measure what employees have achieved against their goals and assess their behavior and development needs. The goal is to both develop and motivate high performers, as well as address issues with poor performers.
Gartner analysts will discuss latest BPM trends at the Gartner Business Process Summit 2011, 7-8 March in London. For further information about the event please visit europe.gartner.com
This document discusses key performance indicators (KPIs) for senior account executives. It provides examples of KPIs, steps for creating KPIs, common mistakes to avoid, and how to design effective KPIs. The document recommends visiting an online site for additional KPI samples and materials related to performance appraisals, review phrases, and interview questions.
The balanced scorecard is a performance measurement framework that was created to address the shortcomings of solely using financial metrics to measure performance. It complements traditional financial measures with non-financial measures covering four perspectives: customer, internal business processes, learning and growth, and financial. The balanced scorecard is used by translating the organization's vision into objectives and measures across the four perspectives, communicating and linking strategic goals throughout the organization, incorporating strategic planning into the budgeting process, and providing feedback to continuously improve strategic performance and change. Many organizations across industries have adopted the balanced scorecard framework.
The document discusses the Balanced Scorecard methodology created by Kaplan and Norton. It presents the four perspectives of the Balanced Scorecard - financial, customer, internal process, and learning and growth. For each perspective, objectives, key performance indicators, targets, and initiatives are identified. The methodology balances both financial and non-financial measures across short and long term goals. It provides a framework for translating an organization's mission and strategy into tangible objectives and measures.
Performance Evaluation PowerPoint PPT Content Modern SampleAndrew Schwartz
136 slides include: 4 benefits and 11 additional values of performance appraisals, performance interviews, ground rules for performance evaluation, building performance contracts, developing work plans, setting the stage for a performance appraisal meeting, opening and closing your appraisal session, handling poor performance, conducting a feedback meeting, how to conduct a performance appraisal discussion, how to's and more.
There's plenty of questions surrounding KPIs and Metrics. What is a KPI? What are KPIs used for? How do I develop KPIs? Who determines KPIs? How do I create a KPI? Which KPIs should I use? When should I use a KPI? Why should I review KPIs? How do I report on KPIs? Which companies use KPIs? KPIs vs Metrics vs Measures vs OKRs? This guide aims to answer all of that and give you resources for more information!
Succession planning involves systematically developing a pipeline of internal talent to fill critical leadership roles when vacancies occur. It aims to identify the best candidates for each position and concentrate resources on developing high-potential employees. An effective succession planning process identifies key roles, assesses current and future competencies needed, evaluates talent, identifies competency gaps, and establishes development plans to fill those gaps. This helps ensure leadership continuity, retain top talent, and prepare new leaders for their roles.
The balanced scorecard is a strategic performance management tool that allows managers to track execution of activities and monitor consequences. It was created by Kaplan and Norton to provide a balanced view of organizational performance across four perspectives: financial, customer, internal business processes, and learning and growth. The balanced scorecard translates an organization's vision and strategy into objectives and measures across these four perspectives, allowing managers to monitor performance and make informed strategic decisions. It has benefits like improved strategy communication and execution, better performance reporting, and better organizational alignment. Many major companies worldwide use the balanced scorecard approach to manage performance.
Health Informatics Journal - Balanced ScorecardJulius Veracion
The document summarizes the design and evaluation of a balanced scorecard for the health information management department at a large urban hospital in Canada. The creation of the balanced scorecard involved 6 months of planning, development, implementation, and evaluation. Key steps included aligning the scorecard with the hospital's strategy, identifying relevant metrics, gathering staff input, and conducting an evaluation survey. The majority of health information management staff agreed that the balanced scorecard is a useful reporting and management tool, supporting the success of developing it for the department. The process used to identify metrics can help other health information management departments create their own balanced scorecards.
Organizations that use a Balanced Scorecard approach tend to outperform organizations without a formal approach to strategic performance measurement
- World-class companies are 159% more likely to have mature BSC in place than less successful organizations
- Among 164 publicly traded companies, those with well-deployed BSC outperformed the control group by nearly 30% (Advances in Accounting, 2008)
- Organizations using BSC outperform the other companies by about 100 percent in having everyone in the organization understand what the organization's strategy is (Norton, The Strategy-Focused Organization, 2000)
The document discusses the balanced scorecard framework. It was developed by Kaplan and Norton as a strategic planning and management system that adds non-financial metrics to traditional financial measures. It includes four perspectives: financial, customer, internal business processes, and learning and growth. Companies use it to translate strategy into objectives and measures, communicate strategy, align initiatives, and provide strategic feedback. The balanced scorecard process involves defining measurement architecture, specifying strategic objectives, choosing measures, and developing an implementation plan. Successful implementation requires commitment from senior leadership and integrating it into the organizational culture.
The document discusses the basics of the balanced scorecard approach. It explains that the balanced scorecard addresses weaknesses of classical strategic planning and performance management by providing an integrated framework. Key aspects include having objectives and metrics in four perspectives (financial, customer, internal processes, innovation and learning) and cascading scorecards from the enterprise level down. The document also discusses how HR can develop an HR scorecard aligned with business strategy to measure its contribution in areas like employee capabilities and satisfaction.
Performance Assessment of Agricultural Research Organisation Priority Setting...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
This document discusses the balanced scorecard (BSC) approach to measuring organizational performance. It provides background on BSC, noting that it integrates financial and non-financial metrics to help organizations translate strategy into tangible objectives. The document then outlines the typical phases of BSC implementation, including strategy synthesis, measure synthesis, technical implementation, organizational integration, technical integration, and ongoing operation. It also discusses linking department-level BSCs to the overall organizational BSC and strategy. Finally, the document reviews prior literature on BSC and performance measurement.
This in our firms' introduction to the concept of the Balanced Scorecard. We use this as part of developing the strategy monitoring and management processes our clients use to insure their strategies stay on track. While this doesn't include our content associated with actually setting up or managing the process, we hope it helps companies who are considering (or struggling with) a BSC implementation.
Summary of this courseHealth care business analysesHealth Care.docxmattinsonjanel
Summary of this course
Health care business analyses
Health Care Business Operations and Performance
Introduction
In this module, you will explore the relationship and potential synergy created by consistent vision, mission, goals, and strategic plan. Health care strategy can be formed in one of two ways: it is intended and deliberate, which is created by plans, or it emerges through a pattern of uncoordinated decisions and actions (it just happens). Plans help to create a deliberate strategy. This is a discovery process in which health care organizations define their markets and assess internal operations. Plans move the organization forward toward the realization of a vision. The strategic plan or plan of action is necessary to achieve certain goals and objectives. The plan helps to create alignment and consensus around the organization's intentions. Key managers help to organize efforts and garner momentum for these strategies.
The Strategic Plan
The strategic plan changes or creates additional service lines, clinical procedures, and geographic locations of new clinics, rooms, or other facilities. The plan helps decide where to allocate resources for the high-level initiatives such as new medical technologies. The plan also identifies potential partners for an integrated delivery network or expanded system. When assessing a health care organization, ask what evidence you see of them attempting to work towards a certain vision. What services are they providing? How do they implement the strategy? How are they different from other clinical organizations in the community? How do they remain competitive?
Operations Internal Assessment and Improvement
Introduction
In this module, you will learn to identify methods of assessing and improving the quality of a health care organization. Developing processes is critical in assessing and improving quality since a process is how work gets accomplished. Until processes are fully documented, the interactions and steps cannot be appreciated. The "as-is process" documents what is actually occurring, versus what is supposed to occur. The "to-be process" documents the vision and the proposed process once improvements have been made. By fixing the process, you improve performance. The business process is a set of activities and tasks that are performed in sequence to achieve a specific outcome. The strategy of process improvement increases the throughput (capacity or volume) of a process; eliminates choke points or bottlenecks; and reduces costs, steps, waste, and resources. Look for steps that add value and eliminate those that do not. Reduce the variation in performance over time, remembering that variability causes resource inefficiency.
Analyzing Performance
Methods for analyzing performance include trend analysis and benchmarking. Trend analysis helps health care organizations answer the question, "How are we performing over time?" Benchmarking asks how we compare to our competition. Benchmarking is th ...
Unveiling the Power of Balanced Scorecard.pdfTEWMAGAZINE
The document discusses the Balanced Scorecard framework, which is a strategic performance management tool that helps organizations translate their vision and strategy into actionable objectives. It incorporates both financial and non-financial metrics across four perspectives: financial, customer, internal business processes, and learning and growth. The Balanced Scorecard aligns organizational performance with strategy, facilitates communication, and drives continuous improvement. Examples from Microsoft and FedEx illustrate how large companies use it to measure progress on objectives related to innovation, customer satisfaction, and internal efficiency. Implementing the Balanced Scorecard framework involves defining objectives and key performance indicators, aligning objectives across perspectives, collecting and analyzing data, and regularly adapting the framework.
The document discusses the balanced scorecard method created by Robert Kaplan and David Norton. It was developed in the early 1990s as a performance management system to address limitations of traditional financial measures. The balanced scorecard translates an organization's strategy into objectives across four perspectives: financial, customer, internal processes, and learning and growth. It links objectives and measures within and across perspectives to represent cause-and-effect relationships between strategic goals. The document outlines the origins and key elements of the balanced scorecard method, including how it can be implemented through a nine-step process involving strategic themes, objectives, mapping, metrics, and data collection.
The document discusses how to link a balanced scorecard to business strategy through cause-and-effect relationships, performance drivers, and financial outcomes. It emphasizes translating strategic goals to all levels of the organization through communication, linking individual goals to the scorecard, and aligning rewards. Regular strategic reviews using the scorecard can validate strategies and drive continuous improvement.
S COMPANIES AROUND THE WORLD transform themselves for c.docxgertrudebellgrove
S COMPANIES AROUND THE WORLD transform themselves
for competition that is based on information, their abil-
ity to exploit intangible assets has become far more
decisive than their ability to invest in and manage
physical assets. Several years ago, in recognition of this change,
we introduced a concept we called the balanced scorecard. The
balanced scorecard supplemented traditional fi nancial measures
with criteria that measured performance from three additional
perspectives – those of customers, internal business processes,
and learning and growth. (See the exhibit “Translating Vision
and Strategy: Four Perspectives.”) It therefore enabled compa-
nies to track fi nancial results while simultaneously monitoring
progress in building the capabilities and acquiring the intangible
assets they would need for future growth. The scorecard wasn’t
Editor’s Note: In 1992, Robert S. Kaplan and
David P. Norton’s concept of the balanced
scorecard revolutionized conventional
thinking about performance metrics. By
going beyond traditional measures of
fi nancial performance, the concept has
given a generation of managers a better
understanding of how their companies are
really doing.
These nonfi nancial metrics are so valu-
able mainly because they predict future
fi nancial performance rather than simply
report what’s already happened. This
article, fi rst published in 1996, describes
how the balanced scorecard can help
senior managers systematically link current
actions with tomorrow’s goals, focusing
on that place where, in the words of the
authors, “the rubber meets the sky.”
Using the Balanced Scorecard
as a Strategic Management System
by Robert S. Kaplan and David P. Norton
A
MANAGING FOR THE LONG TERM | BEST OF HBR | January–February 1996
150 Harvard Business Review | July–August 2007 | hbr.org
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MANAGING FOR THE LONG TERM | BEST OF HBR | Using the Balanced Scorecard as a Strategic Management System
152 Harvard Business Review | July–August 2007 | hbr.org
a replacement for fi nancial measures;
it was their complement.
Recently, we have seen some compa-
nies move beyond our early vision for
the scorecard to discover its value as the
cornerstone of a new strategic manage-
ment system. Used this way, the score-
card addresses a serious defi ciency in
traditional management systems: their
inability to link a company’s long-term
strategy with its short-term actions.
Most companies’ operational and
management control systems are built
around fi nancial measures and targets,
which bear little relation to the com-
pany’s progress in achieving long-term
strategic objectives. Thus the emphasis
most companies place on short-term fi -
nancial measures leaves a gap between
the development of a strategy and its
implementation.
Managers us ...
S COMPANIES AROUND THE WORLD transform themselves for c.docxpoulterbarbara
S COMPANIES AROUND THE WORLD transform themselves
for competition that is based on information, their abil-
ity to exploit intangible assets has become far more
decisive than their ability to invest in and manage
physical assets. Several years ago, in recognition of this change,
we introduced a concept we called the balanced scorecard. The
balanced scorecard supplemented traditional fi nancial measures
with criteria that measured performance from three additional
perspectives – those of customers, internal business processes,
and learning and growth. (See the exhibit “Translating Vision
and Strategy: Four Perspectives.”) It therefore enabled compa-
nies to track fi nancial results while simultaneously monitoring
progress in building the capabilities and acquiring the intangible
assets they would need for future growth. The scorecard wasn’t
Editor’s Note: In 1992, Robert S. Kaplan and
David P. Norton’s concept of the balanced
scorecard revolutionized conventional
thinking about performance metrics. By
going beyond traditional measures of
fi nancial performance, the concept has
given a generation of managers a better
understanding of how their companies are
really doing.
These nonfi nancial metrics are so valu-
able mainly because they predict future
fi nancial performance rather than simply
report what’s already happened. This
article, fi rst published in 1996, describes
how the balanced scorecard can help
senior managers systematically link current
actions with tomorrow’s goals, focusing
on that place where, in the words of the
authors, “the rubber meets the sky.”
Using the Balanced Scorecard
as a Strategic Management System
by Robert S. Kaplan and David P. Norton
A
MANAGING FOR THE LONG TERM | BEST OF HBR | January–February 1996
150 Harvard Business Review | July–August 2007 | hbr.org
R
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M
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an
ck
1284 Kaplan.indd 1501284 Kaplan.indd 150 6/7/07 10:51:38 AM6/7/07 10:51:38 AM
MANAGING FOR THE LONG TERM | BEST OF HBR | Using the Balanced Scorecard as a Strategic Management System
152 Harvard Business Review | July–August 2007 | hbr.org
a replacement for fi nancial measures;
it was their complement.
Recently, we have seen some compa-
nies move beyond our early vision for
the scorecard to discover its value as the
cornerstone of a new strategic manage-
ment system. Used this way, the score-
card addresses a serious defi ciency in
traditional management systems: their
inability to link a company’s long-term
strategy with its short-term actions.
Most companies’ operational and
management control systems are built
around fi nancial measures and targets,
which bear little relation to the com-
pany’s progress in achieving long-term
strategic objectives. Thus the emphasis
most companies place on short-term fi -
nancial measures leaves a gap between
the development of a strategy and its
implementation.
Managers us.
S COMPANIES AROUND THE WORLD transform themselves for c.docxaryan532920
S COMPANIES AROUND THE WORLD transform themselves
for competition that is based on information, their abil-
ity to exploit intangible assets has become far more
decisive than their ability to invest in and manage
physical assets. Several years ago, in recognition of this change,
we introduced a concept we called the balanced scorecard. The
balanced scorecard supplemented traditional fi nancial measures
with criteria that measured performance from three additional
perspectives – those of customers, internal business processes,
and learning and growth. (See the exhibit “Translating Vision
and Strategy: Four Perspectives.”) It therefore enabled compa-
nies to track fi nancial results while simultaneously monitoring
progress in building the capabilities and acquiring the intangible
assets they would need for future growth. The scorecard wasn’t
Editor’s Note: In 1992, Robert S. Kaplan and
David P. Norton’s concept of the balanced
scorecard revolutionized conventional
thinking about performance metrics. By
going beyond traditional measures of
fi nancial performance, the concept has
given a generation of managers a better
understanding of how their companies are
really doing.
These nonfi nancial metrics are so valu-
able mainly because they predict future
fi nancial performance rather than simply
report what’s already happened. This
article, fi rst published in 1996, describes
how the balanced scorecard can help
senior managers systematically link current
actions with tomorrow’s goals, focusing
on that place where, in the words of the
authors, “the rubber meets the sky.”
Using the Balanced Scorecard
as a Strategic Management System
by Robert S. Kaplan and David P. Norton
A
MANAGING FOR THE LONG TERM | BEST OF HBR | January–February 1996
150 Harvard Business Review | July–August 2007 | hbr.org
R
o
b
e
rt
M
e
g
an
ck
1284 Kaplan.indd 1501284 Kaplan.indd 150 6/7/07 10:51:38 AM6/7/07 10:51:38 AM
MANAGING FOR THE LONG TERM | BEST OF HBR | Using the Balanced Scorecard as a Strategic Management System
152 Harvard Business Review | July–August 2007 | hbr.org
a replacement for fi nancial measures;
it was their complement.
Recently, we have seen some compa-
nies move beyond our early vision for
the scorecard to discover its value as the
cornerstone of a new strategic manage-
ment system. Used this way, the score-
card addresses a serious defi ciency in
traditional management systems: their
inability to link a company’s long-term
strategy with its short-term actions.
Most companies’ operational and
management control systems are built
around fi nancial measures and targets,
which bear little relation to the com-
pany’s progress in achieving long-term
strategic objectives. Thus the emphasis
most companies place on short-term fi -
nancial measures leaves a gap between
the development of a strategy and its
implementation.
Managers us ...
Know the basics of Balance Scorecard and its evolution. Also understand perspectives involved into BSC.
PS. The source of the document is as mentioned inside the document.
Chapter 101. Describe the concepts and models of plann.docxcravennichole326
Chapter 10
1. Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
2. Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
3. Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
4. Distinguish the differences between planning and contingency planning.
5. Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
6. Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Chapter 10: Building a Culture of Healthcare Supply Chain Excellence: Leading, Planning, Managing, Deciding, and Learning
Learning Objectives
Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
Distinguish the differences between planning and contingency planning.
Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Introduction
Planning and decision making are essential to efficient, effective and efficacious healthcare supply chain operations and strategies.
Leaders and managers must structure and facilitate plans that integrate well with the healthcare organization’s strategic plan and must make consistent decisions in alignment with those plans.
Creating standing operating procedures for routine and consistent operations of the supply chain allows leaders and managers to spread the operational culture at all levels of the supply chain enterprise.
This chapter provides an overview of planning, improvement strategies, metrics, regulatory compliance and decision making.
These constructs should be reviewed and ...
The document discusses performance excellence models and the balanced scorecard. It begins by exploring different frameworks for evaluating organizational performance, including criteria proposed by Campbell, Welge/Fessman, and Quinn/Rohrbauh. It then examines factors that can generate organizational performance such as structure, culture, strategy and leadership. The document outlines several performance excellence models including the EFQM excellence model and the Baldrige criteria. It provides an overview of the balanced scorecard, including its origins, components, development process, and strategic benefits such as communicating strategy and driving strategy execution.
Appendix CHR Balanced Score CardMetric(Name of Metric)Form.docxjustine1simpson78276
Appendix C
HR Balanced Score Card
Metric**
(Name of Metric)Formula
(Numerator/Denominator)% Met or Exceeded*
HR Routine Metrics
1.
2.
3.
AHROP
HR Strategy Metrics
1.
2.
3.
4.
HR Organizational
Oversight Metrics
1.
2.
3.
*Leave this column blank for future calculations by staff using this form to report data
**You may add lines as need to each of the 3 categories
Journal of Management Development
The balanced scorecard: a new challenge
Meena Chavan,
Article information:
To cite this document:
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doi.org/10.1108/17410400410561231">https://doi.org/10.1108/17410400410561231</a>
(2012),"The politics of the balanced scorecard", Journal of Accounting & Organizational
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https://doi.org/10.1108/02621710910955930
https://doi.org/10.1108/02621710910955930
The balanced scorecard:
a new challenge
Meena Chavan
Business Department, Division of Economic and Financial Studies,
Macquarie University, North Ryde, Australia
Abstract
Purpose – The purpose .
Managers are increasingly recognizing that traditional financial measures alone do not provide all the information needed to make strategic and operational decisions. A balanced scorecard uses a mix of financial and nonfinancial metrics related to customers, internal processes, learning and growth, and shareholder value to give managers a more complete picture. This enables continuous performance improvement, strategic execution, and accountability. The balanced scorecard has gained widespread use as it helps articulate strategy, communicate it, motivate execution, and monitor results.
[To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
This PowerPoint compilation offers a comprehensive overview of 20 leading innovation management frameworks and methodologies, selected for their broad applicability across various industries and organizational contexts. These frameworks are valuable resources for a wide range of users, including business professionals, educators, and consultants.
Each framework is presented with visually engaging diagrams and templates, ensuring the content is both informative and appealing. While this compilation is thorough, please note that the slides are intended as supplementary resources and may not be sufficient for standalone instructional purposes.
This compilation is ideal for anyone looking to enhance their understanding of innovation management and drive meaningful change within their organization. Whether you aim to improve product development processes, enhance customer experiences, or drive digital transformation, these frameworks offer valuable insights and tools to help you achieve your goals.
INCLUDED FRAMEWORKS/MODELS:
1. Stanford’s Design Thinking
2. IDEO’s Human-Centered Design
3. Strategyzer’s Business Model Innovation
4. Lean Startup Methodology
5. Agile Innovation Framework
6. Doblin’s Ten Types of Innovation
7. McKinsey’s Three Horizons of Growth
8. Customer Journey Map
9. Christensen’s Disruptive Innovation Theory
10. Blue Ocean Strategy
11. Strategyn’s Jobs-To-Be-Done (JTBD) Framework with Job Map
12. Design Sprint Framework
13. The Double Diamond
14. Lean Six Sigma DMAIC
15. TRIZ Problem-Solving Framework
16. Edward de Bono’s Six Thinking Hats
17. Stage-Gate Model
18. Toyota’s Six Steps of Kaizen
19. Microsoft’s Digital Transformation Framework
20. Design for Six Sigma (DFSS)
To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations
IMPACT Silver is a pure silver zinc producer with over $260 million in revenue since 2008 and a large 100% owned 210km Mexico land package - 2024 catalysts includes new 14% grade zinc Plomosas mine and 20,000m of fully funded exploration drilling.
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2. BALANCED SCORECARDS FOR SMALL RURAL HOSPITALS:
Concept Overview & Implementation Guidance
Produced by the Mountain States Group, Inc. via funding
provided by the United States Department of Health and Human
Services, Program Support Center, Contract Number #282-98-
0010, Task Order #8
2
3. BALANCED SCORECARDS FOR SMALL RURAL HOSPITALS:
Concept Overview & Implementation Guidance
TABLE OF CONTENTS Page
A. Introduction 4
B. Brief History of Balanced Scorecard Efforts 4
C. Background 6
Definition of Balanced Scorecard 6
Traditional Perspectives 7
Balances 9
D. Modifying BSC Approach 9
Basic Assumptions 10
Principles – Readiness Assessment 11
Engaging/Involving Leadership 12
Education of Internal/External Stakeholders 13
Data: Gathering, Processing, & Benchmarking 14
Building Long-term Sustainability 15
E. Essential Components of Rural BSC Model 16
Readiness Assessment 18
Planning 20
Technical Implementation 34
Organizational Integration 37
Operations/Modification 38
F. Conclusion 38
Appendices
1. Tools/Performance Aids
2. BSC Example
3. Terminology Definitions
4. Additional Resources
3
4. BALANCED SCORECARDS FOR SMALL RURAL HOSPITALS:
Concept Overview & Implementation Guidance
A. INTRODUCTION
The purpose of this publication is to describe the process of implementing a Balanced
Scorecard (BSC) initiative in a small rural hospital setting, including how to identify if an
organization is ready for the implementation phase, what the various steps are in the process,
what key principles need to be considered that are common to rural hospitals, and what a rural
hospital Balanced Scorecard would look like.
This effort was undertaken because of the belief that the Balanced Scorecard can be
useful and adaptable to small rural hospitals, but that the process and approach must be tailored
to their requisite resources (time, expertise, money) in order for implementation to be practical
and successful. Additionally, this publication is an attempt to describe a more relevant
implementation model designed to better fit the needs of rural hospitals.
B. BRIEF HISTORY OF BALANCED SCORECARD EFFORTS
Since the early 1990s when Robert Kaplan, a professor at Harvard University and David
Norton, a consultant from the Boston area, developed the Balanced Scorecard, there have been
many different Balanced Scorecard applications in all types of industries both in the United
States and internationally. Several articles and books have been written on the Balanced
Scorecard methodology and there are a variety of software products to assist and expedite
implementation of this performance measurement process. Historically, performance
improvement systems have focused on measurements and indicators alone. What is unique
about the Balanced Scorecard approach, in contrast to other methods, is that it links strategy with
4
5. performance and goes beyond the traditional financial metrics in determining whether or not an
organization has been successful. Integral to BSC is the notion that an organization’s strategies
and their execution are among the most important factors in performance improvement.
The shift from an industrialized economy to a knowledge/information economy has
necessitated a change in how value is determined. According to management researchers, value
is now associated more with intangible assets (employees/knowledge) than traditional tangible
assets (equipment/plant). Instead of focusing solely on historical financial data, new
management concepts were needed to more effectively assess how well an organization was
performing. Only 35percent of respondents to a Performance Measurement Survey rated their
current performance measurement systems as effective or very effective (American Institute of
Certified Public Accountants and Lawrence S. Maisel, 2001).
In 1999, a Fortune magazine story suggested that 70 percent of CEO failures came not as
a result of poor strategy, but of poor execution. In addition, it is estimated that nine out of ten
organizations fail to implement their strategies1
.
Over the past twelve years, several methodologies have been developed in various
industries to address the need for a more “balanced” way to assess and manage performance (e.g.
Six Sigma, TQM, CQI, etc.). The fields of organizational development and human performance
technology have blossomed in this decade, all focused on better methods to assess and manage
performance in organizations.
The Balanced Scorecard (BSC) now has a documented history of successful
implementation in several industries including healthcare. Benefits of implementation have
included:
1
Balanced Scorecard: Step-by-Step: Maximizing Performance and Maintaining Results; Paul R. Niven; 2002; John
Wiley & Sons, Inc., New York.
5
6. • increased financial returns;
• greater employee alignment to overall goals;
• improved collaboration; and
• unrelenting focus on strategy.
Most healthcare BSC implementations, such as those profiled in Kaplan and Norton’s literature,
have occurred in urban centers that have larger and more specialized staff, IT capacity, and
resources. Smaller hospitals in Arkansas, Michigan, Minnesota, Mississippi, and Pennsylvania
have also used the BSC with promising outcomes.
The challenge is to find a way to implement the Balanced Scorecard in small rural
hospitals that is meaningful, relevant, and affordable.
C. BACKGROUND
Definition of Balanced Scorecard
The Balanced Scorecard is a tool that translates an organization's mission and strategy
into a comprehensive set of performance measures that provides the framework for a strategic
measurement and management system.2
The Balanced Scorecard is an approach for driving
organizational improvement toward pre-selected goals which keeps track of progress through
carefully selected measures. The Balanced Scorecard is also an integrated management system
consisting of three components: 1) strategic management system, 2) communication tool, and 3)
measurement system.3
It results in a carefully selected set of measures derived from and linked
to an organization’s core strategies. The measures selected for the scorecard represent a tool for
2
Balanced Scorecard Collaborative. http://www.bscol.com
3
Balanced Scorecard: Step-by-Step: Maximizing Performance and Maintaining Results; Paul R. Niven; 2002; John
Wiley & Sons, Inc., New York.
6
7. leaders to use in communicating to employees and external stakeholders the outcomes and
performance drivers by which the organization will achieve its mission and strategic objectives.
Companies are using the scorecard to:
• clarify and update strategy;
• communicate strategy throughout the company;
• align unit and individual goals with strategy;
• link strategic objectives to long term targets and annual budgets;
• identify and align strategic initiatives; and to
• conduct periodic performance reviews to learn about and improve strategy.
Traditional Perspectives
There are a number of “balances” in the BSC, among which are the balance or
equilibrium between four historical domains or perspectives considered to be mutually linked in
terms of strategy and performance:
1. Learning and Growth Perspective
2. Internal Process Perspective
3. Customer Perspective
4. Financial Perspectives
Paul Niven’s analogy of the Balanced Scorecard is that of a tree (see Figure 1). The
Learning and Growth perspective are the roots, the trunk is the Internal Process perspective,
Customers are the branches, and the leaves are the Financial perspective. Each perspective is
interdependent on those below as well as those above. It is a continuous cycle of renewal and
growth. Leaves (finances) fall to fertilize the ground and root system, which stimulates growth
throughout the organization. In this analogy, learning and growth is the foundation on which all
7
8. other perspectives are built. For example, if a hospital assesses patient satisfaction and discovers
patients aren’t satisfied (Customer Perspective), one of the strategies might be the
implementation of employee training in the area of customer service (Learning & Growth
Perspective). Improved customer service through a reduction of wait time in the emergency
room (Internal Process Perspective) can ultimately improve utilization (Financial Perspective).
Refer to Figure 2. There are definite cause and effects between and among each of the four
perspectives. The key is to identify the right strategies.
Figure 1
Figure 2
8
9. Balances
One of the reasons the Balanced Scorecard has been so successful is that it is a balanced
approach. This balance includes:
1. Balance between financial and non-financial indicators of success
2. Balance between internal and external constituents of the organization
3. Balance between lag and lead indicators of performance
Internal constituents might include employees whereas external constituents might include
physician groups or insurers. Lag indicators generally represent past performance and might
include customer satisfaction or revenue. Although these measures are objective and accessible,
they lack any predictive power. Lead indicators are the performance drivers that lead to the
achievement of lag indicators and often include the measurement of processes and activities. For
example, ER wait time might represent a leading indicator of patient satisfaction. A Balanced
Scorecard should contain a variety of different measures.
D. MODIFYING THE BALANCED SCORECARD APPROACH
As stated earlier, a modified Balanced Scorecard approach is probably necessary for
small rural hospitals because of a lack of infrastructure in terms of information technology, staff
time and expertise, resources to pay for consultants and ongoing expenses, and the practicality
and meaningfulness of existing measures. The remainder of this document will focus on the
basic assumptions and principles entailed in modifying the process, the actual components of a
modified Balanced Scorecard process, and suggested performance indicators that could be
incorporated into a rural hospital Balanced Scorecard. Figure 3 is an example of the Balanced
Scorecard model described in this publication and adapted from Kaplan and Norton.
9
10. Figure 3
Financial Perspective
“If we succeed, how will we
look to our community?”
Internal Process Perspective
“To satisfy our patients, which
business and medical processes
must we excel at?
Customer Perspective
“To achieve our mission, how
must we look to our patients,
medical staff, and community?”
Learning & Growth Perspective
“To achieve our mission, how
must our organization learn and
improve”
Basic Assumptions
How does a rural hospital know that its strategies give attention to all aspects of
performance? Do they overemphasize expense management versus revenue generation? Do
they address the needs of all customers, including patients, physicians, and the community at-
large? Are internal processes improved to support quality and patient satisfaction goals? Are
resources applied to filling the gaps in skills and knowledge among the staff?
Rural hospitals have many initiatives running concurrently, and at any point in time, it is often
difficult to know the progress (percent completion) and even if they are continuing to move in
10
11. the right direction. For those hospitals seeking to use the Balanced Scorecard as an approach for
performance management, some prerequisites are required:
1. A strategic plan supported by the Board.
2. Accountability for implementation must be assigned to the Administration by the
Board, which retains interest and oversight without micromanaging.
3. Individuals and departments must be provided adequate resources and support
while agreeing to be held accountable, and to hold each other accountable, for
BSC results.
4. Achievable and unambiguous measures of success must be selected.
5. Reporting and monitoring mechanisms need to be accessible, regular, and user-
friendly.
6. The process must be simple, affordable and achievable within existing resources.
Principles
Readiness Assessment
Before attempting to implement a Balanced Scorecard process in any organization, it is
essential that key leadership (administrator/CEO, department managers, board of directors, and
medical staff leadership) are fully committed to the process in terms of involvement, conceptual
understanding, communication, and serving as process “champions”. Without this commitment,
efforts will be significantly hampered and results jeopardized. Before BSC can be successfully
implemented, the organization’s mission, vision, and strategic plan must be well-defined and
current. Because performance measures are dependent on the future strategies identified by the
organization, they should be in place at the outset. Other factors include the need to develop a
11
12. performance management system, the financial resources available for implementation, the
involvement of key individuals who manage data collection systems, and staff time. Refer to
page 16 and Appendix 1 for a discussion and list of readiness assessment tools.
Engaging/Involving Leadership
Gaining the sponsorship and commitment of leadership is not easy. Most administrators
have a myriad of demands that compete for their time and attention and often eliminate those
ideas and activities that seem nonessential. In a study conducted for the Balanced Scorecard
Report, respondents reported that the CEO, more than any other individual, was the sponsors of
the Balanced Scorecard.4
A good way to enlist CEO support is through the demonstration of
results. Success stories of Balanced Scorecard implementations can be found in the literature
(books/articles) and on several Websites: refer to www.bcol.com for healthcare examples.
There are signs that may signal the need for a new performance measurement system in a
rural hospital. These include:
• Performance is acceptable on all dimensions except profit;
• Patients don’t use the facility even when prices are competitive;
• No one notices when performance measurement reports aren’t produced;
• Managers spend significant time debating the meaning of the measures;
• They haven’t changed their measures in a long time;
• They have too many meetings and not enough action;
• Staff says “nothing ever changes here”;
• Department managers do not work in teams effectively to make changes;
4
Balanced Scorecard: Step-by-Step: Maximizing Performance and Maintaining Results; Paul R. Niven; 2002; John
Wiley & Sons, Inc., New York.
12
13. • The same problems keep coming up because root causes are not addressed;
• Administration doesn’t have time to “stay on top of everything”; and
• They recently changed their organization’s strategy.
Education through well designed/delivered presentations on performance management
and the Balanced Scorecard can overcome most serious objections over time. It is essential,
however, that the administrator/CEO must be fully involved and committed in this effort.
Developing and implementing a Balanced Scorecard is a commitment to managing in a different
way – one that commits the organization to certain accountabilities and performance standards.
Ron Heifetz of Harvard University writes: “The real heroism of leadership involves having the
courage to face reality…and help the people around you to face reality.” Effective leadership, he
maintains, is influencing an organization to “face its problems and live into its
opportunities…and mobilizing people to tackle touch challenges.” BSC is not a “one-shot”
process; therefore, those interested in using BSC should view it as a long-term process and be
prepared to commit to change over a longer period of time (3 to 5 years).
Education of Internal & External Stakeholders
It is imperative that whomever initiates the process has a good understanding of Balanced
Scorecard concept and theory, and can communicate this clearly to all leadership (CEO, senior
administrative team, physicians, department managers, and board of directors). Leadership
members need to understand this concept and be prepared to educate others in the facility. The
key to successful implementation hinges on clearly communicating to everyone in the facility
their respective role(s) in achieving specific performance measures and gaining organization-
wide support and commitment. Appendix 1 contains an overview of the challenges faced by
13
14. nurses, managers, administrators, and board members and how the Balanced Scorecard can help
with solutions.5
Data: Gathering, Processing, & Benchmarking
One of the key principles in the Balanced Scorecard process is identifying those
indicators that accurately measure the accomplishment of strategies. There should also be a
cause and effect relationship between the strategies selected and the overall mission of the
organization. Another important consideration is the infrastructure for data collection. IT
infrastructure varies widely among rural hospitals; some will have sophisticated IT systems,
while others have virtually none. The existing facility infrastructure should be considered when
implementing the Balanced Scorecard. In addition to infrastructure issues, staff expertise and
time must be considered. One of the benefits of developing a Balanced Scorecard is that it
should help to eliminate unnecessary collection and reporting of data by identifying only those
measures that are linked to strategies. Time spent on collecting and reporting data that has no
direct bearing on achievement of performance strategies can be minimized. Because an
organization “has always done it this way” is not a good reason to continue.
Finally, the concept of benchmarking deserves some consideration. Benchmarking can
be internal or external. With internal benchmarking, a hospital selects a set of measurements and
indicators that tie to internal standards established without regard to performance by peer
hospitals (e.g., maximum waiting times for an outpatient visit, the maximum time before a
patient is greeted in the Emergency Department, the percentage of patient bills that are error-
free). Internal benchmarking focuses on the rate of improvement rather than reaching an
external standard or benchmark. External benchmarking relies on standards and measurements
5
Provided by Stroudwater Associates
14
15. that relate to peer hospitals. Many small hospital networks, as well as vendors have relevant
financial, quality, and process data available that allow hospitals to compare themselves to others
of a similar size and service profile. External benchmarking data can be useful in helping to
determine whether a hospital’s performance is comparable to its peer group. However, external
data is not always comparable between geographic regions, the cost of obtaining data may be
beyond the financial resources of some hospitals, and the greatest danger to external
benchmarking is regression to the mean. For example, if one hospital’s days in accounts
receivables are 65 and the rural average is 65, does that mean that opportunities for further
improvement should be ignored? Hospitals need not rely on the most “exotic” data they can
find. Using common internal indicators or using data from regional networks and alliances can
provide good results while keeping costs down and reducing the staff burden for data collection.
Building Long-term Sustainability
There have been a number of companies that embark on implementing Balanced
Scorecard efforts, only to discover they lack the time, commitment, and resources to ensure these
efforts are integrated into everyday activities. Perhaps the information received didn’t convince
them of the value, or they may have chosen measures that don’t accurately reflect strategies, or
they didn’t expect the process to be as time-consuming as it can be, or they simply failed to fully
implement the process. Implementing a Balanced Scorecard is not something that can be
accomplished overnight. CEOs in particular, should be patient. The process takes time, requires
changes within an organization at all levels, and is not something that once completed is
forgotten.
15
16. The principles outlined above should be used to guide the Balanced Scorecard
implementation. There are no hard and fast rules. This may be as much art as science at this
point, even though developments in the field are producing remarkable results.
E. ESSENTIAL COMPONENTS OF A RURAL BSC MODEL
The following are phases or steps in a typical Balanced Scorecard process. Within each
phase are activities that need to occur. This section starts with an overview of each of the phases
and then explores each phase in greater detail. This process is an adaptation of the process
described by Kaplan and Norton.6
Phases: (refer to Figure 4)
Readiness Assessment: identify needs, resources, and confirm leadership commitment.
Planning: identify leadership and participants for BSC team, complete a review of
mission/vision/values/strategies, assign strategies to BSC perspectives, develop strategy map,
identify and agree upon measures, and develop implementation plan.
Technical implementation: visions, strategies, measures entered into system via software or
training, building scorecards, setting target and alarm (or alert) levels, data consolidation rules,
defining graphs and reports (presentation of data), importing historical measurement data/
creating reports.
Organizational integration: integrate Balanced Scorecard with management and reporting
processes and communicate to all members (staff and stakeholders), definition of persons
responsible for measure data and empowerment, explanation of Balanced Scorecard objectives,
6
“Using the Balanced Scorecard as a Strategic Management System” by Robert S. Kaplan and David P. Norton;
Harvard Business Review; 2000.
16
17. re-engineering management and strategy process, re-engineering reporting process, regular
reviews tied to compensation.
Operation/Modification: data update, analysis, and reporting regularly within routine processes;
refinement, update measure values/analyze results/report results/refine model or process.
Figure 4
Operation/Modification
Data Update
Analysis
Regular Reporting
Refinement
Organizational Integration
Integrate w/Existing
Communicate Objectives
Assign Measurement Data Responsibility
Technical Implementation
Input Information
(vision/strategies/measures)
Build Scorecards
Set Targets and Alert Levels
Standardize Data Definitions
Presentation of Data
Readiness Assessment
Identify Needs
Identify Resources
Confirm Leadership Commitment
Planning
Leadership Team
Strategic Review
(mission/vision/strategic plan)
Assign Strategies to BSC
Perspectives
Develop Strategy Map
Identify/Agree on Measures
Develop Implementation Plan
17
18. Readiness Assessment
One of the first areas an organization should consider is determining the value and the need
for implementing a Balanced Scorecard process. An examination of current performance
measures may help identify problem areas. Use this simple tool to assess your existing
measures.7
Consider your measures as a group and rate them as follows:
1) No value on this goal
2) Some help on this goal
3) Quite helpful on this goal
4) Extremely valuable on this goal
How well do your performance measures:
____ Translate your business strategy into concrete actions?
____ Align departments with common goals?
____ Fully reflect what your stakeholders care about?
____ Provide the leverage to create change?
____ Balance leading and lagging indicators?
____ Balance strategic and operational indicators?
____ Enhance strategic and operational indicators?
____ Enhance your ability to compete in the future?
____ Drive improvements in how work is performed?
____ Include internal and external benchmarks to judge performance?
____ Total Score
A score of less than 18 suggests your measures are falling down on the job; if your
total is 18-27, there’s solid value in your measures but also room for improvement;
scores over 27 indicate your measures are among the best.
*see page 43 for a reproducible version of this tool
Other factors to consider are what resources are available in terms of existing IT
infrastructure, staff time and expertise, and money to afford technical assistance if necessary.
What type of IT infrastructure exists? Do staff know how to use basic software? What data is
currently collected and how? Are there resources to bring in consultants to help facilitate the
7
Measuring Performance: Using the new metrics to deploy strategy and improve performance; Dr. Bob Frost,
Measurement International; 2000.
18
19. process? The following checklist might help assess the question of resources. Paul Niven
includes another good assessment tool in his latest book “Balanced Scorecard Step-by-Step for
Government and Nonprofit Agencies (p.56).8
Yes No Resource Availability
Does your facility have a computer network?
Does the senior leadership have computers? (CEO/CFO/DON)
Does the senior leadership have access to the Internet?
Does the senior leadership know how to use a word processing program?
(e.g. Word, Word Perfect)
Does the senior leadership know how to use a spreadsheet program? (e.g.
Excel)
Does the senior leadership know how to use presentation software? (e.g.
Powerpoint)
Do department managers have computers?
Do department managers have access to the Internet?
Do department managers know how to use a word processing program? (e.g.
Word, Word Perfect)
Do department managers know how to use a spreadsheet program? (e.g.
Excel)
Do department managers know how to use presentation software? (e.g.
Powerpoint)
Can your facility afford to hire a consultant?
Can your facility afford the cost of benchmarking data?
*see page 44 for a reproducible version of this tool
Finally, the most significant factor to consider is whether there is a strong commitment
from leadership including the administrator/CEO, administrative team, department managers,
and the board of directors. Implementation of any type of performance improvement or
performance management system will mean change. Without the absolute commitment of senior
leadership, pushing these changes down throughout the organization (“cascading”) will be
difficult at best. Implementation of the Balanced Scorecard will create significant culture change
that is ongoing. If the senior leadership team is resistant to change or is unwilling to share power
8
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John Wiley & Sons, Inc.,
New York, New York, 2003.
19
20. and control, the organization may want to consider a different approach to performance
improvement.
The following is a simple way to assess whether your facility may be a good candidate
for a Balanced Scorecard implementation (adapted from Niven).9
This is an example of how
you might use it in a facility.
Criteria Score
(out of 10)
Weight Total
Points
Rationale
Leadership Commitment 8 30 percent 2.40
Defined Strategy 3 25 percent .75
Need 8 15 percent 1.20
Resources 4 15 percent .60
Support of Participants 4 10 percent .40
Available Data 3 5 percent .15
Total 30 100 percent 5.50
A score of 5.5 out of ten might suggest additional consideration be given those areas with
a score under 5. Lack of resources or a well-defined strategy are things that should be addressed
prior to implementation.
Planning
The first step is to identify the individual “champion” (typically the hospital
administrator) who will lead this process and then build the Balanced Scorecard team. Niven
9
Balanced Scorecard: Step-by-Step: Maximizing Performance and Maintaining Results; Paul R. Niven; 2002; John
Wiley & Sons, Inc., New York
20
21. suggests that a 7 person team is ideal. This number may be challenging for small rural hospitals
and 5 may be more attainable. In any group, it is essential to get a mix of complementary skills
and personalities. Individuals selected should possess a commitment to the common purpose and
approach and be held accountable. In addition to the hospital administrator, you’ll need an
individual to coordinate the Balanced Scorecard implementation, someone who is well organized
and detail oriented, and individuals who will serve as active members of the team. The
following chart describes roles and responsibilities.
Role Responsibilities
Hospital Administrator • Assumes primary ownership for the Balanced Scorecard project
• Provides background information to the team on strategy and methodology
• Maintains communication with administration and management
• Commits resources (both human and financial) to the team
• Provides support and enthusiasm for the Balanced Scorecard throughout the
organization
Balanced Scorecard
Coordinator
• Coordinates meetings; plans, tracks, and reports team results to all audiences
• Provides thoughtful leadership on the Balanced Scorecard methodology to the
team
• Ensures that all relevant background material is available to the team
• Provides feedback to the executive sponsor (co-leaders) and management
• Facilitates the development of an effective team through coaching and support
Team Members • Provide expert knowledge of business unit or functional operations
•
Act as Balanced Scorecard ambassadors within their unit or d
Inform and influence their respective peers and co-workers
epartment
•
•
Act in the best interests of the business as a whole
21
22. Once the team is established, a review of the organization’s mission, vision, values, and
strategies should be completed. It is
essential that organizational strategies be
current and relevant. If these elements
don’t exist or if they haven’t been updated
within the past year or so, then efforts
should be made to update them. This can
be accomplished by a skilled facilitator at a
retreat. Usually the facility’s leadership
team, department managers, medical staff,
and governing board members participate.
It is essential that consensus on the
contents of the mission, vision, values, and
strategic plan is achieved.
Once the strategic plan is well
defined, strategies are reviewed to
determine where they fit within the four Balanced Scorecard perspectives: Learning and
Growth, Internal Processes, Customers, and Financial. Some organizations discover the need to
add another perspective. There is no hard and fast rule that limits an organization to the four
perspectives, as they serve as a template. For purposes of this publication, however, we chose to
focus on these four perspectives.
Kathy Garthe, CEO/Head Coach, Leelanau
Memorial Health Center – Michigan, describes
the need to have a vision for the hospital that
drives the hospital’s strategies and
performance. She sees the BSC as an “ideal
tool to manage these strategies”. She has
incorporated the Baldridge quality principles
into their BSC and describes the BSC as an
effective tool for TQM. Her small rural
hospital currently has 38 strategic measures
which they call “key critical success factors”.
The BSC is reviewed monthly. Financially,
the hospital has gone from a -13% margin in
2000 to a +3% in 2003, although part of that
could be attributed to CAH conversion.
Kathy Garthe says in her hospital’s
experience: “Strategic objectives become the
focus of individuals and departments
throughout the hospital. Progress throughout
the year is easily measured against objectives.
The need for corrective actions can be
identified and addressed in a timely manner.
More team oriented objectives evolve in
support of strategic objectives. BSC Makes
complex issues and tasks easier to
understand.”
For example, an overall goal “To maintain high level of commitment and involvement of
hospital staff, volunteers and board members through education, recognition, and support” with a
22
23. strategy that states “Provide employee in-services focused on improving patient care”, would fit
under the Learning and Growth perspective.
Example
Financial
Internal Process Customers
Learning & Growth
Strategy 1: Provide
employee in-services focused
on improving patient care
Once you have taken your strategies and grouped them under the appropriate Balanced
Scorecard perspectives, then the next step would entail identifying measures of strategy
achievement. Using the example above, the measure might be the number of employee
participants or number of in-services provided or both.
Kaplan and Norton suggest that once an organization’s core strategies are established,
that a “strategy map” is created .10
A strategy map represents how the organization creates value
and visually shows the detailed objectives in each of the four perspectives required for success.
10
Kaplan, R.S. and Norton, D.P., Strategy Maps, Converting Intangible Assets into Tangible Outcomes; Harvard
Business School Press, Boston, Massachusetts; 2004.
23
24. Both Kaplan and Norton and Paul Niven11
have written extensively on the strategy mapping
process and how to go about it.
A strategy map is based on the following principles:
o Strategy balances contradictory forces (e.g. investing in intangible assets for long-
term revenue growth conflicts with cutting costs for short-term financial
performance)
o Strategy is based on a differentiated customer value proposition (e.g. clear
articulation of targeted customer segments (patients, medical staff) and what it
costs to please them)
o Value is created through internal business processes (e.g. operations management,
customer management, innovation, regulatory and social)
o Strategy consists of simultaneous complementary themes (e.g. each internal
process improvement delivers benefits at different points in time)
o Strategic alignment determines the value of intangible assets (e.g. learning and
growth consists of human capital, information capital, and organization capital)
Strategy mapping provides a graphical representation of an organizational model that
shows the relationships (cause and effect) between various strategic objectives. It’s a picture
story of how successful implementation of performance initiatives result in achievement of
strategies and how they are interrelated and dependent upon each other. Although Kaplan and
Norton devote an entire book to the subject of strategy maps12
, Niven has a well-written process
11
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John Wiley & Sons, Inc.,
New York, New York, 2003.
12
Kaplan, R.S. and Norton, D.P., Strategy Maps, Converting Intangible Assets into Tangible Outcomes; Harvard
Business School Press, Boston, Massachusetts; 2004.
24
25. on how to develop a strategy map13
. He recommends the involvement of all members of the
Balanced Scorecard team, including the CEO, in a full-day session led by an outside consultant
or facilitator. All participants should have a copy of the mission, vision, values, and strategic
plan. He suggests the use of a SWOT Analysis on the four perspectives of the Balanced
Scorecard (Learning and Growth, Internal Processes, Customers, and Financial) as a mental
warm-up to development of objectives for each of the four perspectives. The following table is a
summary of the questions that might be explored in each of the four perspectives.
Perspective Questions to Ask
Learning and Growth Which organizational infrastructure elements are necessary if we are to
achieve our process and customer objectives?
Which skills and competencies do our employees require now?
Which skills and competencies will be required in the years ahead?
Do our employees have access to the information they need to help us
achieve our customer outcomes?
Is our organizational climate conducive to success?
Do we have a strong culture and alignment of goals throughout?
Internal Process To continue adding value for our customers and clients, at what
processes must we excel?
After analyzing current trends, which processes might we be expected
to develop and excel at in the foreseeable future?
Customer Perspective Who are our targeted customers?
Howe do we “add value” for our customers?
Which services or products do our customers require and expect from
us?
Financial Perspective Is our service delivered at a good price?
How can we maintain current service levels while remaining within our
budget?
What opportunities do we have for enhancing revenue?
The questions outlined should generate hours of stimulating discussion. A good
facilitator will help identify key words that can be used to create the essence of important
objectives. There is no hard and fast rule for the number of objectives in a BSC. A good
13
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John Wiley & Sons, Inc.,
New York, New York, 2003.
25
26. guideline, however, is “less is generally better”. Niven suggests capping the number of
objectives between 10 and 20. Well-written objective statements will provide precise
clarification of the meaning, outline why the objective is important, discuss how the objective
will be accomplished, and describe how the objective links in the chain of cause and effect
evident in the strategy map. Once the objectives have been identified and objective statements
developed, ask these questions:
• Is the cause-effect logic in the map complete? Are all the necessary elements to tell the
story accounted for?
• Is the logic reflected in the map theoretically sound? Do all the elements fit together
logically?
• Will the objectives outlined on the map lead to the effective execution of our strategy?
• Does the map represent balance in our
efforts to achieve our mission?
Without the strategy map as a communication
tool, it is difficult to express strategy changes
as they occur. This model has already been
implemented in several hospitals. The
following is a graphic representation that
describes the construction of a strategy map.
The names of the perspectives are designed to represent the operations within a hospital.
Joe Hammond, North Sunflower Hospital-
Mississippi remarked that “he finally
understood the full impact of the BSC the day
his hospital created their BSC Strategy Map”.
He realized the BSC was “far more than a
measuring tool”, but also provided a
framework for managing the hospital’s most
important business. He also saw it as a means
of communicating strategy to both his board
and his entire staff. He notes the need for
strong executive leadership and commitment
and describes the BSC process as a distance
race rather than a sprint.
26
27. Hospital’s Vision/Mission/Values
Finance
How do we need to perform financially to achieve our mission?
Community & Providers (Customer)
How do we meet the needs/expectations of our community,
patients, and physicians?
Clinical & Business Processes (Internal)
At which business and healthcare delivery processes must we
excel?
Learning & Growth
What type of culture, skills, training, and technology are we
going to develop to support our processes?
Once consensus has been obtained on which perspectives to use and what to name them,
the process of identifying strategies, objectives, and measures can begin. A search of the Internet
using the search words “strategy map” produces several examples of strategy maps. There is no
one “right” strategy map for all rural hospitals. Each facility must look at its mission, vision,
values, and strategies and develop a strategy map based on those items. An example of a
strategy map developed for a rural hospital as part of the Delta Rural Hospital Performance
Improvement (RHPI) Project is on page 30.
Following the development of a strategy map, one of the more time consuming activities
is the identification of specific measures that will be used to track accomplishment of strategic
objectives. Measuring performance has been a hospital task since long before the development
of the Balanced Scorecard. The trick is making sure the right things are being measured.
27
28. 28
There are three types of performance measures: input measures, output measures, and
outcome measures. Input measures include staff time or budgetary resources. Output
measures include number of people served or units produced by a program or service. Input and
output measures demonstrate effort expended and numbers served but tell little about whether
these interventions are making a difference. Outcome measures track the benefit received by
stakeholders as a result of an organization’s efforts. Most would agree outcome measures
provide the best information for decision-making. A Balanced Scorecard should include a mix
of input, output, and outcome measures and a mix of lag and lead indicators. Lag indicators
measure whether targets have been met, while lead indicators measure progress along the way.
Employee satisfaction is an example of a lag indicator while absenteeism is an example of a lead
indicator.
30. The essential objective in selecting specific measures for a scorecard is to identify the
measure that best communicates the meaning of a strategy. There are several core outcome
measures that Kaplan and Norton have identified and include:
Core Financial Measures
• Return-on-investment/economic value-added
• Profitability
• Revenue growth/mix
• Cost reduction productivity
Core Customer Measures
• Market share
• Customer acquisition
• Customer retention
• Customer profitability
• Customer satisfaction
Core Learning and Growth Measures
• Employee satisfaction
• Employee retention
• Employee productivity
Measures should be developed for each of the perspectives agreed upon. In the process
identifying measures. There will no doubt be more measures than resources to collect the data,
• linked to your strategy,
of identifying measures, refer to the table on page 19 for questions to ask in the process of
so it is important to narrow these measures to the critical few that are:
30
31. • are easy to understand,
• can be linked together in a chain of cause and effect,
• can be updated frequently,
• are accessible,
• portray a true picture of the process or event you’re attempting to capture,
• are resistant to date related measures,
• are quantitative, and
• functional.
Once measures have been identified, the team should spend time refining the measures,
assigning ownership, and identifying data requirements. This would be a good time to gather
employee feedback on the measures to make sure they are practical and represent cause-effect
linkages. Once consensus on the measures has been obtained, the Balanced Scorecard team can
establish targets for the measures.
There are any number of measures that a rural hospital might select. Using the strategy
map on page 30 and the four perspectives Learning & Growth (Learning & Knowledge), Clinical
& Business Processes (Internal Processes), Community and Providers (Customer), and Finance
(Financial), these measures might include:
Learning & Growth
o Nursing Staff Turnover
o Staff Turnover
o Staff Loyalty Index
o Medical Error Policy
o Staff Training Dollars
31
32. o Access to Training
o Mission Index
o Staff Engagement Index
Clinical & Business Processes (Internal Processes)
o Contractual Allowances
o Bad Debt Expense
o Net Days in A/R
o Unbilled A/R
o MD Engagement Index
o Average Age of Plant
o Falls: Acute Care
o Falls: Swing Beds
o Medical Error Rate
o ER Wait Time
o Responsiveness
o ACE Inhibitor Delivery
o Beta Blocker Delivery
o Antibiotic Delivery
o Aspirin Delivery
Community & Providers (Customer)
o MD Loyalty Index
o Time to Treating Provider
o Courtesy & Respect
32
33. o Patient Engagement
o Inpatient Satisfaction
o Emergency Department Satisfaction
o Patient Access Index
Finance (Financial)
o Operating Profit Margin
o Days Cash on Hand
o Commercial Mix
o Net Revenue Increase
o Cost Per Patient Day
o Salary & Benefit Expense
o Nursing Staff Productivity
The last activity in the Planning
Phase is the development of a plan for
implementation of the Balanced Scorecard
system. This plan should include a budget,
expected milestones, risk analysis, a
description of your IT (information
technology) system, terminology and
definitions, Balanced Scorecard elements
and structure, and clear identification of who will be responsible for what activities. This plan
should include how the BSC information will be communicated throughout the organization and
Russ Sword, CEO Ashley County Hospital,
Arkansas, speaks of the need resources to
sustain BSC operations after the initial flurry
of development activity. There are immediate
rewards and benefits, but it takes persistence
and continuing education to drive the BSC
approach into the hospital culture. At Ashley
County Hospital a BSC team leads the
implementation of the Performance
Improvement and BSC initiatives. Currently
the hospital is measuring forty different
performance indicators and is benchmarking
its performance with 15 other hospitals.
33
34. how feedback from employees will be obtained and integrated. This plan will form the basis for
the technical implementation and technical and organizational integration efforts that follow.
Technical Implementation
A clearly articulated plan should identify the organization’s mission, visions, values,
strategies, and measures. This plan should also identify the information technology
infrastructure within the facility as well as it’s strengths and limitations. The risk analysis should
cost out any modifications needed in your IT infrastructure to enable those responsible for data
gathering and reporting to carry out their functions.
Some hospital may have the resources needed to purchase existing Balanced Scorecard
software. There are a number of vendors that sell complete software systems that provide the
structure needed to complete the entire Balanced Scorecard process. If a packaged software
system is desired, a request for proposals should be developed, including an on-site product
demonstration, detailed information on training and support, and assurance the software is
compatible with the existing IT system. The authors of the Gartner report “Weighing the
Options - Balanced Scorecard Software”, Bernard Marr and Andy Neely, have written a new
book entitled Automating Your Scorecard: The Balanced Scorecard Software Report.14
This
report is produced every year and last updated at the end of 2003 with the aim to help
organizations through the software selection maze. The book has been designed to guide
organizations through the process of selecting the right software solution by offering a decision
framework, as well as detailed evaluations of all of the major BSC software products available
14
http://www.som.cranfield.ac.uk/som/cbp/BScorecard.html
34
35. 35
today. Additionally, Microsoft’s OS 2003 is reported to include a specific BSC software
program, scheduled for release the end of May 2004 at a cost of less than $1,000.
If the hospital doesn’t have the resources to purchase off-the-shelf software, data can be
collected, entered, analyzed, and reported utilizing standard office software such as Microsoft
Office. Training in the use of all of Microsoft’s applications (Word, Excel, Access, Powerpoint)
is typically available either through the Internet, through local vendors certified to teach
Microsoft software applications, or through community colleges.
Scorecards can be built directly from the strategy map. A scorecard can be a table or
graphic that shows previous performance, the target, and current performance. An example of a
scorecard is provided on page 37.15
Well designed scorecards give attention to target and alarm (or alert) levels, data
consolidation rules, defining graphs and reports, importing historical measurement data, and
creating reports. Reports can be generated for management purposes, the medical staff, the
governing board, or all three. A management report might include all data in graph form for all
four perspectives. A medical staff report might only include those data related to clinical
processes (patient satisfaction, cost per discharge, etc.). A report to the governing board might
not include all the details that a management report would have. The Balanced Scorecard team
can help design and refine the scorecards and reports that will flow out of the data collection
process. Appendix 2 contains an example of the process to implement a simplified Balanced
Scorecard.
15
Stroudwater & Associates
37. Organizational Integration
The most important aspect of the organizational integration phase is communication. All
Balanced Scorecard team members as well
as all employees, medical staff, and
governing board members must have a
clear understanding of the structure of the
facility’s Balanced Scorecard, who is
responsible for gathering the data, inputting
the data, analyzing the data, generating
reports, and communicating the results to
the various stakeholders. One of the
benefits of this process is the identification of reports and measures that may no longer be
needed. Another aspect of this phase is what
Niven refers to as “cascading” or the process of
developing aligned scorecards throughout an
organization.16
Each level of the organization
will develop scorecards based on the objectives
and measures it can influence. Cascading
allows every employee to demonstrate a
contribution to overall organizational objectives.
Teresa Fisher, Director of Operational
Development, speaks of the benefits that the
BSC brought to the Pine Medical Center Staff,
Sandstone, MN. "I love the BSC. With the
BSC you always have your headlights on. The
employees become aware of where the
hospital is going and can participate fully. The
department leaders can also align their
department activities to the hospital's
strategies. They can better anticipate resource
needs and plan for the future more effectively.
People get used to checking the satisfaction
scores to see how they're doing; they come to
own the results. In our hospital there has been
a strong correlation between staff awareness of
hospital direction and staff satisfaction."
Peter Person, CEO of the SMDC Health
System (4 hospitals and 25 community clinics
in MN, WI, and MI) says: "BSC aligned the
entire organization through a common set of
well understood objectives and created a
platform for developing a single organizational
culture. It increased executive, management
and physician/staff accountability with clearly
defined targets and was an effective
communications tool for everyone. It led to a
$20M financial turnaround and return to
profitability."
16
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John Wiley & Sons, Inc.,
New York, New York, 2003.
37
38. Operation/Modification
The final phase is ongoing and includes data updates, analysis, and reporting regularly
within routine processes; refinement of measure values; analysis of results; and refinement of the
model. Once you have several quarters of data collected, measures can be analyzed to determine
if they are truly linked to the identified strategy. This phase requires an objective review of your
established processes to be certain they are providing accurate information upon which to base
decisions. This refinement process should continue throughout the life of the organization as
change is inevitable.
Conclusion
The implementation of a Balanced Scorecard process in small rural hospitals is different
from that of a Fortune 500 company. These differences include:
• Overall framework aligned around strategy to achieve a mission and vision as opposed
to meeting the requirements of shareholders;
• Customer complexity – role of patients, physicians, and payers must be reflected in
process and measures;
• Scope – process must fit resource availability of providers; affordability and ease of
implementation are critical.
This publication is an attempt to lay the foundation for understanding the complexities
and benefits of the Balanced Scorecard performance improvement initiative through the
exploration of guiding principles and a description of various phases of Balanced Scorecard
implementation. These phases include:
Readiness assessment
38
39. Planning
Technical implementation
Organizational integration
Operation/modification
The appendices contain various examples of assessment tools, a simplified example of the BSC
process, terminology definitions, and additional resources (books, articles, and Websites).
Falls Memorial Hospital, International Falls, MN was down to 5 days cash on hand when
Mary Klimp became CEO in late 1998. On the Canadian border in northern Minnesota, the
hospital is 100 miles away from any secondary center and 165 miles from a tertiary care
center in Duluth. ADC was 3.5, Margin - 3 %. They did strategic planning in 1999 and
began the BSC in 2000. Without outside consulting assistance, they put the BSC on an
Excel spread sheet and used the scorecard with their board, administration, medical staff,
department managers and with all staff. It was part of the orientation of every new
employee and was posted throughout the hospital. The implementation process took 9
months but she estimates that ongoing implementation takes no more than 7 hours a month.
Currently Falls Memorial is measuring 16 different performance indicators on its BSC
They attribute a remarkable turnaround in hospital performance to the BSC. As of late
2003, the hospital had nearly 100 days cash on hand, a profit margin of 15 % and had
undertaken extensive capital expansion. It's inpatient census had also more than tripled to
11. Leadership attributes the improvement primarily to the BSC.
Mary Klimp says: "Don't start from scratch use existing data if available. Pick a few vital
indicators -- fewer is better than too many. Communicate and educate at all levels-
frequently. Continue to reinforce the balanced perspective. Don't wait for the perfect
measures-refine as you go along. It takes time to bake the scorecard into the organization's
daily work".
Mary says that "My proudest BSC moment was when I met a housekeeper in the hall who
remarked that the BSC indicated that the hospital was doing great and that she was proud
to work here." Mary believes that this widespread staff understanding of strategy has been
important marketing for the hospital.
39
42. ASSESSING EXISTING MEASURES
Consider your measures as a group and rate them as follows:
1 - No value on this goal
2 - Some help on this goal
3 - Quite helpful on this goal
4 - Extremely valuable on this goal
How well do your performance measures:
____ Translate your business strategy into concrete actions?
____ Align departments with common goals?
____ Fully reflect what your stakeholders care about?
____ Provide the leverage to create change?
____ Balance leading and lagging indicators?
____ Balance strategic and operational indicators?
____ Enhance strategic and operational indicators?
____ Enhance your ability to compete in the future?
____ Drive improvements in how work is performed?
____ Include internal and external benchmarks to judge performance?
____ Total Score
A score of less than 18 suggests your measures are falling down on the job; if your
total is 18-27, there’s solid value in your measures but also room for improvement;
scores over 27 indicate your measures are among the best.
42
43. RESOURCE ASSESSMENT
Yes No Resource Availability
Does your facility have a computer network?
Does the senior leadership have computers? (CEO/CFO/DON)
Does the senior leadership have access to the Internet?
Does the senior leadership know how to use a word processing program?
(e.g. Word, Word Perfect)
Does the senior leadership know how to use a spreadsheet program? (e.g.
Excel)
Does the senior leadership know how to use presentation software? (e.g.
Powerpoint)
Do department managers have computers?
Do department managers have access to the Internet?
Do department managers know how to use a word processing program? (e.g.
Word, Word Perfect)
Do department managers know how to use a spreadsheet program? (e.g.
Excel)
Do department managers know how to use presentation software? (e.g.
Powerpoint)
Can your facility afford to hire a consultant?
Can your facility afford the cost of benchmarking data?
43
44. Appendix 2: BALANCED SCORECARD EXAMPLE
The following is an example of how one might develop a Balanced Scorecard. The information
included is fictional and is provided to simply demonstrate the process.
Anytown Hospital has just finished a two-day retreat where they revised and updated their
mission and vision statements and drafted a strategic plan. The hospital’s vision statement is:
The vision of Anytown Hospital is to be the community’s provider of choice.
The hospital’s mission statement is:
Anytown Hospital is committed to providing the highest quality of health care through
service excellence and compassionate care
During their retreat, the hospital board and leadership identified the following strategies to
pursue the upcoming year.
• Operate in the black with 5 percent margin by increasing revenues
• Motivate, recognize and retain staff
• Provide high quality services
• Increase utilization of services
The Anytown Hospital administrator enlisted the help of the department managers to implement
a performance improvement process and Balanced Scorecard. First, they took these strategies
and placed them into their appropriate perspectives as follows:
Financial Perspectives (Business
& Development)
• Operate in the black with 5%
margin by increasing revenues
Customer Perspective (Patients
& Community)
• Increase utilization of services
Internal Process Perspective
(Quality & Safety)
• Provide high quality services
Learning and Growth
Perspective (Staff & Clinicians)
• Motivate, recognize and retain
staff
44
45. NOTE: Once strategies are categorized according to the four perspectives, if there are
imbalances, determine if they are significant and either add or remove strategies accordingly.
The next step is to determine the causal linkages between the strategies and develop a strategy
map to visually portray how your strategies support your mission and vision. One of the primary
reasons for developing a strategy map is that it should clearly communicate the connection
between strategies and mission and is an excellent communication tool. The following is
Anytown Hospital’s strategy map.
Learning and Growth Perspective (Staff & Clinicians)
Motivate, recognize and retain staff
Internal Process Perspective (Quality & Safety)
Provide high quality services
Customer Perspective (Patients & Community)
Increase utilization of services
Financial Perspectives (Business & Development)
Operate in the black with 5% margin by increasing revenues
RESULTS IN
RESULTS IN
RESULTS IN
MISSION: Anytown Hospital is committed to providing the highest quality of health care
through service excellence and compassionate care
45
46. Once you have your strategy map, you can start identifying what actions you will take to achieve
strategies and how you will measure the progress in accomplishing each strategy. The following
are a few examples of actions you might implement under each strategy and two measures that
could be used to track accomplishment of each strategy. For purposes of this example, both a lag
(historical performance) and a lead (predictor of future performance) indicator are used.
Learning and Growth Perspective (Staff & Clinicians):
Motivate, recognize and retain staff
ACTIONS:
Develop performance based compensation
Develop peer recognition program
Review/update salary/benefits to ensure competitiveness
MEASURES:
Employee satisfaction (lag indicator)
Turnover rate (lead indicator)
Internal Process Perspective (Quality & Safety):
Provide high quality services
ACTIONS:
Review ER patient flow process and streamline
Review ER staffing to ensure adequacy
Implement automated pharmaceutical dispensing
MEASURES:
percent ER patient triaged within 15 minutes of arrival (lead indicator)
Medication errors per dose (lag indicator)
Customer Perspective (Patients & Community):
Increase utilization of services
ACTIONS:
Implement customer service
Implement marketing plan
MEASURES:
Patient satisfaction in 95 percent-tile (lag indicator)
Average daily census (lead indicator)
46
47. Financial Perspectives (Business & Development):
Operate in the black with 5 percent margin by increasing revenues
ACTIONS:
Review billing and collections processes for accuracy and timeliness
Develop incentive program for AR staff
MEASURES:
Net revenue increase over prior year (lag indicator)
Decrease net days in accounts receivable (lead indicator)
Once the measures are identified, you’ll need to determine whether the data is currently available
or will need to be collected. For example, you may already have data on employee terminations
that could be used to calculate turnover rate on a monthly basis by department. You may have to
purchase or design employee or patient satisfaction surveys to solicit their input. Employee
surveys can be completed quarterly or annually and patient satisfaction surveys could be
ongoing.
After data sources have been
identified, the team
(administrator/department
managers) should assign
responsibility for the collection of
this data. Individuals within the
business office would probably
collect the net revenue and AR
data; someone who manages
human resources or salary/payroll
functions might be responsible for
collecting data on turnover rates or
employee satisfaction; the
individual responsible for quality
assurance or improvement might
be responsible for collecting data
on ER triage time or medication
errors; etc. (see example to right)
Assignments should be made to an
individual to collect data, and the team should establish timelines for collection, deadlines for
reporting, targets (what you hope to achieve) and report formats. Using the example above, at
the end of each month, the HR manager gets the employee data from whoever processes payroll
and enters it into the spreadsheet. He/she then generates a chart showing the trends. Refer to
Figure 1. The deadline for completion of this task is established at the 5th
of each month, the
target is established at “0 percent” or no turnover, and the HR manager is responsible for
submitting the data to the team in the agreed upon format.
EXAMPLE
The human resource manager could set up a simple
excel spreadsheet that contains total employees by
department by month and terminations (both voluntary
and involuntary) within each department. A ratio of # of
terminations divided by total employees per department
could be calculated easily and tracked each month. That
data could be aggregated for the entire facility as well.
If, for example, you have a large number of voluntary
terminations (people are quitting), you could determine
in which department these tend to occur and implement
exit interviews to determine cause. If the terminations
are involuntary (people are fired), you might want to
review the reasons for termination and/or the hiring
practices to make sure the best candidates are being
hired.
47
48. Figure 1
Each responsible individual is given the task of collecting the data, analyzing the data, and
reporting the data back to the team. The team can then discuss options, modify actions or
activities intended to achieve strategies, or just keep tabs on progress.
A Balanced Scorecard could be put together by simply including each report generated by the
team members or designated individuals. On the following page is a simplified report of four
measures – employee turnover, percentage of patients seen in ER within 15 minutes, patient
satisfaction, and average days in accounts receivables. For each chart, the target is included.
This example of a Balanced Scorecard is oversimplified but it doesn’t need to be anymore
complicated than a few charts with relevant data. This information can be collected, stored,
analyzed, and reports generated in Microsoft Office products or other similar software products.
48
50. Appendix 3: TERMINOLOGY DEFINITIONS17
1. Activity measures: These measures typically track the actions or behaviors an
organization performs using its inputs of staff time and financial resources.
2. Balanced Scorecard: An integrated framework for describing and translating strategy
through the use of linked performance measures in four balanced perspectives:
Customer, Internal Processes, Learning and Growth, and Financial. The Balanced
Scorecard acts as a measurement system, strategic management system, and
communication tool.
3. Benchmarking: The comparison of similar processes across organizations and industries
to identify best practices, set improvement targets, and measure progress.
4. Cascading: The process of developing aligned Scorecards throughout an organization.
Each level of the organization will develop Scorecards based on the objectives and
measures it can influence from the Scorecard of the group to which they report.
5. Cause and effect: The concept of cause and effect separates the Balanced Scorecard from
other performance management systems. The measures appearing on the Scorecard
should link together in a series of cause-and-effect relationships to tell the organization’s
strategic story.
6. Customer perspective: One of the four standard perspectives used with the Balanced
Scorecard. The role of the Customer perspective is often elevated to the top of the
Balanced Scorecard model in public-sector and nonprofit organizations.
17
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John Wiley & Sons, Inc.,
New York, New York, 2003.
50
51. 7. Efficiency measures: These measures evaluate the cost of each unit of service delivered.
They typically begin with “cost per…”.
8. Employee learning and growth perspective: One of the four standard perspectives used
with the Balanced Scorecard. Measures in this perspective are often considered
“enablers” of the measures appearing in the other three perspectives. Employee skills,
availability of information, and organizational climate are often measured in this
perspective.
9. Financial perspective: One of the four standard perspectives used with the Balanced
Scorecard. In public-sector and nonprofit applications of the Balanced Scorecard,
measures in the financial perspective are viewed as constraints within which the
organization must operate.
10. Government Performance and Results Act (GPRA): Signed into law in 1993, the GPRA
requires federally funded agencies to develop and implement an accountability system
based on performance measurement, including setting goals and objectives and measure
progress toward achieving them. The law emphasizes what is being accomplished as
opposed to what is being spent.
11. Human capital: May be considered a metaphor for the transition in organizational value
creation from physical assets to the capabilities of employees-knowledge, skills, and
relationships. Human capital is closely related to terms such as intellectual capital and
intangible assets. Recent estimates suggest that as much as 75 percent of an
organization’s value is attributable to human capital.
12. Initiatives: The specific programs, activities, projects, or actions an organization will
undertake in an effort to meet performance targets.
51
52. 13. Input measures: These measures track resources used to drive organizational results.
Typical inputs include staff time and financial resources.
14. Internal processes perspective: One of the four standard perspectives used with the
Balanced Scorecard. Measures in this perspective are used to monitor the effectiveness
of key processes the organization must excel at in order to continue adding value for
customers, given the finite resources available.
15. Lagging indicator: Performance measures that represent the consequences of actions
previously taken are referred to as lag indicators. They frequently focus on results at the
end of a time period and characterize historical performance. Employee satisfaction may
be considered a lag indicator. A good Balanced Scorecard must contain a mix of lag and
lead indicators.
16. Leading indicator. These measures are considered the “drivers” of lagging indicators.
There is an assumed relationship between the two that suggests improved performance in
a leading indicator will drive better performance in the lagging indicator. For example,
lowering absenteeism (a leading indicator) is hypothesized to drive improvements in
employee satisfaction ( a lagging indicator).
17. Measure: A standard used to evaluate and communicate performance against expected
results. Measures are normally quantitative in nature, capturing numbers, dollars,
percentages, and so on. Reporting and monitoring measures help an organization gauge
progress toward effective implementation of strategy.
18. Mission statement: A mission statement defines the core purpose of the organization –
why it exists. The mission examines the underlying principle for the organization, and
52
53. reflects employee motivations for engaging in the organization’s work. Effective
missions are inspiring, long term in nature, and easily understood and communicated.
19. Objective: A concise statement describing the specific things organizations must do well
in order to execute its strategy. Objectives often begin with action verbs such as
“increase”, “reduce”, “improve”, “achieve”, and the like.
20. Outcome measures: These measures track the benefit received by stakeholders as a result
of the organization’s operations. They may also be known as impact measures. Outcome
measures track the extent to which an organization has achieved its overall goals.
Possible examples include: “reduce incidence of HIV” and “increase perception of
public safety”.
21. Output measures: These measures track the number of people served, services provided,
or units produced by a program or service. Number of inoculations provided and number
of potholes filled are examples.
22. Perspective: In Balanced Scorecard vernacular, perspective refers to a category of
performance measures. Most organizations choose the standard four perspectives
(Financial, Customer, Internal Processes, Learning and Growth); however, the Balanced
Scorecard represents a dynamic framework, and additional perspectives may be added as
necessary to adequately translate and describe an organization’s strategy.
23. Stakeholder: Any person or group that has a “stake” in the success of the organization.
Stakeholders for public and nonprofit organizations may include: employees, customers
and clients, funders, elected officials, citizens, special-interest groups, suppliers, media,
financial community, and partners. All stakeholders must be considered when
53
54. developing mission, values, vision, strategy, and Balanced Scorecard objectives and
measures.
24. Strategic management system: Describes the use of the Balanced Scorecard in aligning
an organization’s short-term actions with strategy. Often accomplished by cascading the
Balanced Scorecard to all levels of the organization, aligning budgets, and business plans
to strategy, and using the Scorecard as a feedback and learning mechanism.
25. Strategic resource allocation: The process of aligning budgets with strategy by using the
Balanced Scorecard to make resource allocation decisions. Using this method, budgets
are based on the initiatives necessary to achieve Balanced Scorecard targets.
26. Strategy: Represents the broad priorities adopted by an organization in recognition of its
operating environment and in pursuit of its mission. Situated at the center of the
Balanced Scorecard system, all performance measures should align with the
organization’s strategy. Strategy remains one of the most widely discussed and debated
topics in the world of modern organizations.
27. Strategy map: Balanced Scorecard architects Kaplan and Norton coined this term to
describe the interrelationships among measures that weave together to describe an
organization’s strategy.
28. Target: Represents the desired result of a performance measure. Targets make
meaningful the results derived from measurement and provide organizations with
feedback regarding performance.
29. Value proposition: A value proposition describes how an organization will differentiate
itself to customers and the particular set of values it will deliver. To develop a customer
value proposition, many organizations will choose one of the three disciplines articulated
54
55. by Treacy and Wiersema in the Discipline of Market Leaders: operational excellence
(WalMart), product leadership (Nike), or customer intimacy (Nordstrom).
30. Values: Values represent the deeply held beliefs within the organization and are
demonstrated through the day-to-day behaviors of all employees. An organization’s
values make an open proclamation about how it expects everyone to behave. Values
should endure over the long term and provide a constant source of strength for an
organization.
31. Vision: A powerful vision provides everyone in the organization with a shared mental
framework that helps give form to the often abstract future that lies ahead. Effective
visions provide a word picture of what the organization intends ultimately to become,
which may be 5, 10, or 15 years in the future. This statement should not be abstract; it
should contain as concrete a picture of the desired state as possible, and provide the basis
for formulating strategies and objectives.
55
56. Appendix 4: ADDITIONAL RESOURCES
Books
Frost, B., Measuring Performance: Using the New Metrics to Deploy Strategy and Improve
Performance; Measurement International, Dallas, Texas, 2000.
Goldratt, Eliyahu, The Goal – A Process of Ongoing Improvement; Second Edition, The North
River Press, Great Barrington, Massachusetts, 1992.
Hammer, Michael, Beyond Reengineering – How the Process-Centered Organization is
Changing Our Work and Our Lives; HarperCollins Publisher, Inc., New York, New York, 1997.
Harbour, J.L., The Basics of Performance Measurement; Productivity Press, Portland, Oregon,
1997.
Kaldenberg, D. O., Mylod, D. M., & Drain, M. (2002), Patient-Derived Information: Satisfaction
with Care and Post-Acute Care Environments; In N. Goldfield, M. Pine, and J. Pine (Eds.),
Measuring and managing health care quality: Procedures, techniques, and protocols (2nd ed.,
pp. 4:69-4:89). New York: Aspen Publishers.
Kaplan, Robert S. and David P. Norton, The Strategy-Focused Organization: How Balanced
Scorecard Companies Thrive in the New Business Environment; Harvard Business School Press,
2000.
Kaplan, R.S. and Norton, D.P., The Balanced Scorecard, Translating Strategy into Action;
Harvard Business School Press, Boston, Massachusetts; 1996.
Kaplan, R.S. and Norton, D.P., Strategy Maps, Converting Intangible Assets into Tangible
Outcomes; Harvard Business School Press, Boston, Massachusetts; 2004.
Niven, P.R., Balanced Scorecard Step-by-Step: Maximizing Performance and Maintaining
Results; John Wiley & Sons, Inc., New York, New York, 2002.
Niven, P.R., Balanced Scorecard Step-by-Step for Government and Nonprofit Agencies; John
Wiley & Sons, Inc., New York, New York, 2003.
Senge, P.M., The Fifth Discipline: The Art & Practice of the Learning Organization; Currency
Doubleday, New York, New York, 1990.
Senge, P.M., Ross, R., Smith, B., Roberts, C., and Kleiner, A., The Fifth Discipline Fieldbook:
Strategies & Tools for Building a Learning Organization; Doubleday, New York, New York,
1994.
56
57. Stolovitch, H.D. and Keeps, E.J. Editors, Handbook of Human Performance Technology:
Improving Individual and Organizational Performance Worldwide, Second Edition; The
International Society for Performance Improvement; Jossey-Bass/Pfeiffer, San Francisco,
California, 1999.
Articles/Newsletters
Andra Gumbus, D. E. B., Bridget Lyons (2003). "A Three Year Journey to Organizational and
Financial Health Using the Balanced Scorecard: A Case Study at a Yale New Haven Health
System Hospital." Journal of Business & Economic Studies 9(2): 54-64.
Andra Gumbus, B. L., Dorothy Bellhouse (2002). "Journey to Destination 2005." Strategic
Finance 84(2): 46-50.
Andrus D, Kohout FJ. “The Effect of Rural Consumer Satisfaction on Outshopping for Medical
Services.” Health Mark Q, 1984;2(2-3):171-184.
Bainbridge, Darlene, MSRN (2003). “Why Such Interest in the Balanced Scorecard? From
Common Sense to Health Sense.” Cuba, NY. 2: 12.
Blizzard, R. (2003). “Engagement Key to Improving Balanced Scorecards.” Gallup Poll Tuesday
Briefing. Princeton.
Castaneda-Mendez, Kicab, Anne Marie Lavery (1998). "The Role and Application of the
Balanced Scorecard in Healthcare Quality Management." Journal for Healthcare Quality 20(1):
10-13.
Chow, C. W., Ganulin, D., Haddad, K., and Williamson, J. “The Balanced Scorecard: A Potent
Tool for Energizing and Focusing Healthcare Organization Management.” Journal of Healthcare
Management 43, No.3 (1998): 63-80.
Clark, P. A., Drain, M., Malone, M. P. “Addressing Patients' Emotional and Spiritual Needs.”
Joint Commission Journal on Quality and Safety, 2003, 29(12), 659-70.
Cleverley, W. O. (2001). "Financial Dashboard Reporting for the Hospital Industry." Journal of
Health Care Finance 27(3): 30-40.
Curtright, Jonathon W., Eric S. Edell, MD (2000). "Strategic Performance Management:
Development of a Performance Measurement System at the Mayo Clinic." Journal of Healthcare
Management 45(1): 58-68.
Fitzpatrick, Melissa A., MSN (2002). "Let's Bring Balance to Health Care." Nursing
Management 33(3): 35-37.
Griffith, John R., J. A. A., PhD (2002). "Measuring Comparative Hospital Performance." Journal
of Healthcare Management 47(1): 41-57.
57
58. Hill, Terry (2001). “Rural Hospital Performance Improvement: A Comprehensive Strategy to
Improve Quality and Patient Safety.” Duluth.
Hoffman, David C., “Strategy Letter: Applying the Balanced Scorecard to Small & Rural
Hospitals.” Hoffman & Associates, Ltd.; davidhoffmanconsulting.com.
Hoffman, David C., (2003). “Translating the Balanced Scorecard into Action.” Madison,
Wisconsin.
Inamdar, Noorein, and Robert S. Kaplan. “Applying the Balanced Scorecard in Healthcare
Provider Organizations.” Journal of Healthcare Management, 47:3, May/June 2002, 179-195.
Inamdar, NS, Helfrich Jones, ML, Menitoff, R. (2000). "The Balanced Scorecard: A Strategic
Management System for Multi-Sector Collaboration and Strategy Implementation." Quality
Management in Health Care 8(4): 21-39.
Johnson, Mary, RN (2003). “Balancing Act; Implementing the Balanced Scorecard Method.”
Physician, Minnesota
Kaplan, RS, Norton, DP (1992). "The Balanced Scorecard - Measures That Drive Performance."
Harvard Business Review 70(1): 71-79.
Kaplan, RS, Norton, DP (1993). "Putting the Balanced Scorecard to Work." Harvard Business
Review 71(5): 134-140.
Kaplan, RS, Kaplan, DP. (1996). "Using the Balanced Scorecard as a Strategic Management
System." Harvard Business Review 74(1): 75-85.
Kaplan RS, Norton DP. “The Balanced Scorecard. Business: The Ultimate Resource.”
Cambridge, MA: Perseus Publishing, 2002:303-304, 510-511, 101-1011.
Norton, RS, Kaplan, D. P. (2000). "Having Trouble with Your Strategy? Then Map It." Harvard
Business Review 78(5): 167-176.
Kaplan RS, Norton DP. (2004) “Measuring the Strategic Readiness of Intangible Assets.”
Harvard Business Review 82(2): 52-64.
Kaplan, RS, Nevius, AS (2003). “Defining Complex Customer Relationships in Healthcare with
the BSC.” Balanced Scorecard Report.
Kaldenberg, D. O. (1999). “Patient Satisfaction and the Role of Choice.” Marketing Health
Services, 19(3), 39-42.
Kershaw R, Kershaw S. “Developing a Balanced Scorecard to Implement Strategy at St.
Elsewhere.” Management Accounting Quarterly, Winter 2001.
58
59. Lauritsen, K. “Translating Vision to Action: Putting Strategy to Work.” Cedar Rapids.
MacStravic, SP. (1999). "A Really Balanced Scorecard." Health Forum Journal 42(3): 64-67.
Meliones J. “Saving Money, Saving Lives.” Harvard Business Review 2000; Nov/Dec:57-64
Meliones, Jon N., Richard Liekweg, William Burton (2001). "No Mission . . . No Margin: It's
That Simple." Journal of Health Care Finance 27(3): 21-30.
Oliveira J. “The Balanced Scorecard: An Integrative Approach to Performance Evaluation.”
Healthcare Finance Management 2001 May;55(5):42-6.
Pineno, C. J. (2002). "The Balanced Scorecard: An Incremental Approach Model to Health Care
Management." Journal of Health Care Finance 28(4): 69-80.
Pink, George H., Ian McKillp, E. G. S., Colin Preyra, Catherine Montgomery, G. Ross Baker
(2001). "Creating a Balanced Scorecard for a Hospital System." Journal of Health Care Finance
27(3): 1-20.
Press, I. “Patient Satisfaction: Defining, Measuring, and Improving the Experience of Care.”
Chicago, IL: Health Administration Press, 2002.
Report, B. S. (2001). “Sustaining Margin, Mission, and Vision at St. Mary's/Duluth Clinic.”
Balanced Scorecard Report.
Santiago, Jose M. (1999). "Use of the Balanced Scorecard to Improve the Quality of Behavioral
Health Care." Psychiatric Services 50(12): 1571-1576.
Schneiderman AM. “Why Balanced Scorecards Fail.” Journal of Strategic Performance
Measurement, January 1999; pp. 6-11.
Sullivan, T. (2001). "Scorecards Ease Businesses' Balancing Act." InfoWorld 23(2): 32-33.
Voelker, Kathleen, Richard French (2001). "The Balanced Scorecard in Healthcare
Organizations: A Performance Measurement and Strategic Planning Methodology." Hospital
Topics 79(5): 13-25.
Weber, D. O. (2001). "A Better Gauge of Corporate Performance." Health Forum Journal 44(3):
20-24.
Zellman, WN (2003). "Use of the Balanced Scorecard in Health Care." Journal of Health Care
Finance 29(4): 1-16.
59
60. Web sites
Balanced Scorecard On-line
www.BSCol.com
Balanced Scorecard Article - What is a Balanced Scorecard
www.activitybasedmgmt.com/Balanced_Scorecard.htm
Six Sigma and the Balanced Scorecard
www.healthcare.isixsigma.com/me/balanced_scorecard
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