Board Quality Scorecard James Pappas, MD, MBA

The speaker does not have any relevant financial relationships with any commercial interests

Board Quality ScorecardAgenda

Definition and purpose

General structure

Examples

Definition and Purpose

This practice has evolved over time:

As the name implies, a scorecard is used to “keep track” of something (usually many things). In the

business world scorecards were traditionally used almost exclusively to track financial performance.

…from its early use as one-dimensional measure of

financial performance to a strategic planning and measurement system.

This transition is:• Resource intensive• Not easy

The Balanced ScorecardThe scorecard as a strategic planning tool introduced the

‘balanced scorecard’

Financial/ Stewardship

“Financial Performance”

Internal Business Process

“Efficiency”

Organizational Capacity

“Knowledge & Innovation”

Customer/Stakeholder

“Satisfaction”

Vision & Strategy

Strategic ObjectivesPerformance Measures and Targets

Strategic initiatives

http://balancedscorecard.org/Resources/About-the-Balanced-Scorecard

• A scorecard… – Should not be one-dimensional– Should contain a ‘balance’ of

things important to an organization:• E.g., customer & employee

satisfaction, financial performance, and process measures

– Should ‘connect’ vision and strategy with activity at the ‘front line.’

To summarize…

• A balanced scorecard is a powerful tool to keep leaders informed and focused on organizational issues and strategies.– As such, the board should be involved in choosing metrics.

• Balanced scorecards not only monitor progress, they also help with setting expectations:– Create an organizational focus for what is important.– Link leadership strategy (and accompanying tactics) with activities of

front line workers.– Help to make sense out of a multitude of data.

Board Quality ScorecardAgenda

Definition and purpose

General structure

Examples

Simple Rules for Scorecards

• Simple is good– Avoid complicated tables of numbers; graphs are much better.

• Measure what is important– Depends on vision and strategy as well as what level of the

organization the scorecard is used, e.g., Board, c-suite, departmental, or front line.

• The data MUST BE accurate• Actually use the data to make improvements.

– Use your own performance and/or the high standards and best practices of others as benchmarks to improve—NOT the AVERAGES of others.

• Review often, for example, at EVERY Board meeting.

Nursing Scorecard Simple Rules

• Simple is good– For example, the “stop light” approach

• Measure what is important– Finances

• Agency Labor Use– Safety

• CAUTI Incidence• Falls Requiring Intervention• Falls Requiring Intervention, Quarterly• Falls With Injury• HAPU Incidence• HAPU Prevalence

– Process• Patient Education

The stop light and graph approach allows visualization

Nursing Scorecard AVOID TABLES of NUMBERS!

• At a glance:– Four measures of CAUTI, all in control– Two have trended in right direction this quarter– Two have had statistically significant changes

Dept July Actual

Monthly Av

%Diff

% Diff from July last yr.

Year-to-date values%

Diff

This YTD as % Diff of Last

YTDActual Plan

20 91 91.3 -0.3 -0.9 90.8 91.3 -0.6 -0.3

12 54 70 -23 -10 69.3 70 -1 -0.4

19 124 129 -3.9 0 132 129 2.3 1.5

Nursing Scorecard

• “A picture is worth a thousand words”

• Graphs are ‘pictures of data’• Again, AVOID complex tables of

numbers—the human brain is BAD with this kind of data.

Graphs, please!

But we don’t have the resources…

• Measure what you can• Involve the Board• Make it as visual as possible. If dashboard is manual:

– Itemize what is being measured– Instead of red and green lights, can have pluses and minuses– Instead of SPC charts, can have run or line charts

• Use the scorecard to actually make improvements– Create a culture of continuous improvement

Avoid complex tables of data

Board Quality ScorecardAgenda

Definition and purpose

General structure

Examples

CEO Dashboard

• Daily:– Number of Outpatient visits and “No-Shows”– First Surgical Case Start-time– Patient Volume (# admissions)– Emergency Dept.:

• Time from entrance to seeing a “Doc”• Time from Decision to Admit to leaving ED for Ward• Number of patients who leave without being seen

– Overtime/Per Diem costs– Any major service issue– Any major staff Engagement issue

CEO Dashboard• Quarterly Issues to monitor:

– Quality Metrics:• Process of care metrics• Outcome metrics• Patient Satisfaction metrics

– Employee Metrics: (a minimum of quarterly employee forums)• Turnover rate• Employee engagement

– Physician Metrics:• Referral patterns, number• Physician satisfaction/Engagement

– Philanthropy– Board Communication (should be more frequent, but not daily)

The End