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Practical Steps To Implement The Balanced Scorecard
A Case Study
National Healthcare Leadership ConferenceInnovation in Health Services:
From Local Leadership to National Performance
June 12, 2007
Russ Sword, FACHEChief Executive Officer
Ashley County Medical CenterCrossett, AR
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Ashley County Medical Center
• Russ D. Sword, FACHE• Chief Executive Officer
Ashley County Medical CenterCrossett, AR
• Master of Hospital Administration Virginia Commonwealth University, 1973
• [email protected] • (870) 364-1295
Presenter
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Ashley County Medical Center
• New, 46 Bed Acute Care Hospital (1998)
• Designated as a Critical Access Hospital (October 1, 2004), with 25 Acute Care Beds and 8 Geriatric Psychiatric Beds
• Owned by Ashley County (1% Sales Tax for Construction)
• No Tax Support for Operations
• Managed by local Non-Profit Corporation
Hospital Background
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Ashley County Medical Center
1998 (13)
8 General/Family
1 General Surgeon
1 Internal Medicine
1 Radiologist
1 ER w/Agency
1 Psychiatrist
2007 (21)
9 General/Family
1 General Surgeon
1 Internal Medicine
1 Radiologist
2 ER
1 Psychiatrist
1 OB/GYN
1 Oncologist
1 Pulmonologist
1 ENT Surgeon
1 Pediatrician
1 Cardiologist
Medical Staff
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Ashley County Medical Center
ACMC Leadership
Administration HR Marketing
Nursing Quality/PI Finance
BSC Project Team
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Ashley County Medical Center
• ACMC and the Balanced Scorecard
• What the Balanced Scorecard Is Not
• Data Collection Process
• Balanced Scorecard Reports
• Performance Improvement and Market Share
Presentation Topics
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Ashley County Medical Center
Balanced Scorecard
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Ashley County Medical Center
• Provide a framework to translate strategy into operational terms
• Create a systems approach to form an integrated Strategic Management Process
• Provide a tool for communicating the:
– strategy
– processes and systems required for implementing the strategy
• Draw a cause and effect roadmap in a one page strategy map
BSC Objectives
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Ashley County Medical Center
The Balanced Scorecard measures strategy.
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Ashley County Medical Center
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Ashley County Medical Center
Quarter 1Strategy Map, Themes and Leadership Agendas
CEO Checklist
D Communications Plan Implemented
D Strategy Map Adopted by Board of Trustees
D Process Owners Identified
D Management Agenda Restructured
D Board Agenda Restructured
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Ashley County Medical Center
Quarter 2First Report, Targets and Initiatives
CEO Checklist
D Review and Approve First Scorecard Report
D Link Initiatives to Strategy Map
D Implement “Strategy Focused” Management Agenda
D Implement “Strategy Focused” Board Agenda
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Quarter 3Cascading and Department Integration
CEO Checklist
D Identify Departments for Cascading
D Balanced Scorecard Education
D Indicator Selection and Target Setting
D Scorecards Linked into Department Meetings
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Ashley County Medical Center
Quarter 4Embedding the Balanced Scorecard
CEO Checklist
D Update the Strategic Plan using the Scorecard
D Link the Budget to the Scorecard
D Link Performance Evaluations to the Scorecard
D Link Compensation to the Scorecard
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Ashley County Medical Center
Balanced Scorecard at ACMC
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Ashley County Medical Center
• Mountains of unused data
• Tie performance to strategy
• What do patients think?
• What do employees think?
• What do physicians think?
• How do we compare with other similar organizations?
• How can we improve our performance?
Why the Balanced Scorecard?
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• A magic bullet that will automatically “fix”every problem or produce results
• Just another benchmarking project that generates more data
• Something that will exist without commitment and effort
The Balanced Scorecard is NOT:
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Ashley County Medical Center
• RPM Program (www.myrpm.org)
• Data input monthly (online) 30 – 45 minutes
• Integrated Survey Process– All inpatients (90% response)
– All ER patients (40% response)
– Selected op departments
– Employee surveys (semi annual)
– Physician surveys (semi annual)
All surveys are mailed to RPM for scanning, analysis, and report preparation
How are we using the BSC?
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Ashley County Medical Center
• Everything is online
• We can select from a menu of system generated reports
• We can develop custom reports
• We can track our progress over time
• We can compare with other similar institutions
RPM Program
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Ashley County Medical Center
Reports
• Quarterly Board Reports
• Dashboards and Scorecards
• Patient Satisfaction Drill Downs
• Staff Satisfaction Drill Downs
• Patient Level CMS Core Measure Reporting
• ED visit-specific wait times
• Peer group rural hospital benchmarking
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Ashley County Medical Center
1. Detail Data For Management
2. Custom Reports for:
– Employees
– Medical Staff
– Board
– Public
Internal Reporting
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• Focus on “Human Issues”
– Employee satisfaction
– Patient satisfaction
– Physician satisfaction
What we have done
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Customer Service Standards
1. Escort patients /guests
2. Do not “explain away” complaints
3. “Knock” on doors
4. “Respect”
5. Name and title
6. Call lights
7. Appropriate time frame
8. Educate patients
9. Work as a team (“stat” situations)
10.Smile
11.Safety
12.Privacy of Patient Information Escort patients /guests
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Employee Satisfaction
• 401K Improvements
• Customer Service Star of the Month
• Employee of the Year
• Nurse of the Year
• CEO Monthly Roundtable
• Non-Punitive Medical Error Reporting Program
• OmniCel Medication Retrieval System
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Manager Development Institute
• Working Effectively with People
• Leadership Styles
• Change
• Conflicts & Decisions
• Performance Management
• Feedback & Coaching
• The Customer & You
• Groups and Teams
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Physician Satisfaction
• PACS System
• Changed Radiology Contract
• Nighthawk radiology Coverage
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Ashley County Medical Center
Executive Incentive Compensation
• Currently Use BSC as part of CEO Incentive Compensation
• Department Managers planned for 2007
• Employees planned for 2008
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Ashley County Medical Center
• The use of the Scorecard is an ONGOING PROCESS
• The Scorecard ASKS questions, it doesn’t answer them
• As a rule, most of the data are available, it’s just not pulled together in a way that is meaningful
• For this to be successful, we have to look at it with HONESTY
Some Observations
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Questions and Comments