Developing a Balanced Score Card Session 3- Measures

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Developing a Balanced Score CardSession 3-
Measures
Viki Massey, Manager Quality Accreditation
A Joint Venture of London Health Sciences
Centre and St. Josephs Health Care London
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What cannot be defined, cannot be measured
what cannot be measured cannot be improved, and
what cannot be improved will eventually
deteriorate.
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BSC as a Measurement System
Financial

Vision and Strategy
Customer Relations
Internal Service Process
Learning, Innovation and Growth
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Translating with the BSC

• Desired state
• Differentiating activities
• What must be done
• well to implement
• strategies
• How strategic
• success is
• measured

Mission Vision
Strategy/Goals
Objectives In each perspective
Measures In each perspective
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Definition of a Performance Measure

• A measurement tool, screen or flag which is
  used as a guide to monitor, assess and improve
  the quality of patient care, support services and
  functions

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Two Methods of Measurement

• Direct Measures
• -Provide information about specific processes or
  quality characteristics
• Indicators
• - A measure of one very important characteristic
  which can be considered to be representative of
  an entire product or service

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Performance Measures and Quality

• Using measures/indicators is one way of
  monitoring quality of care and services
• Indicators are not a direct measure of quality
• We can measure performance as it relates to
  dimensions of quality

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Dimensions of Quality

• Safety- potential risks are avoided or minimized
• Competence- the knowledge and skills are
  appropriate to the service being provided
• Acceptability- all service provided meets the
  expectation of the client/patient
• Effectiveness- the service, interventions or
  action achieve the desired results

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Dimensions of Quality

• Appropriateness- the services are relevant to the
  client/patient needs and based on established
  standards
• Efficiency- achieving the desired results with
  the most cost effective use of resources
• Accessibility- ability of the client/patient to
  obtain the service at the right place and time
  based on need
• Continuity- ability to provide uninterrupted,
  coordinated service

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Identifying Measures/Indicators

• Key questions
• How do we know that the desired results are being
  achieved?
• What measures will tell us whether the desired
  results are being achieved?
• What quality dimensions relate to each indicator?
• Are there any aspects of quality not being
  addressed?

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Examples of Indicators
Financial Perspective
Internal Service Process Perspective

• Monthly budget variance
• Replacement cost (loss rate)
• Repair Maintenance costs

• Turn Around time
• Laboratory Occurrences- specimen processing,
  safety
• Repeat tests
• Workload units
• System/Equipment downtime

Learning, Innovation, and Growth
Customer Relations Perspective

• Customer satisfaction
• Customer wait times
• Laboratory Occurrences- corrected reports

• Turnover rate ( of staff in 6 months)
• Absenteeism rate ( of staff in 3 months)
• Attendance at in-services ( attending)
• Staff education ( of budget devoted)

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Developing Useful Measures/Indicators

• Measure only what you intend to take action on
• Know which indicators are important and why
• Create measures that track process
  performance

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Developing Useful Measures/Indicators

• Be selective - limit to the vital few
• Rely on existing data wherever possible
• Distinguish between what is nice to know and what
  is need to know

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Criteria for Choosing Proper Measures/Indicators

• Measures need to be
• appropriate and relevant
• feasible or do-able
• affordable
• valid (it measures what you want it to measure)
• reliable (it remains consistent with repeated use)

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Exercise 1

• Form 4 groups- one for each perspective
• Within each group
• Appoint a scribe/presenter
• Brainstorm measures/indicators
• Record all measures/indicators
• Present measures/indicators to other groups
• Record other measures/indicators as suggested by
  the other groups

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Exercise 2

• Review Measures/Indicators generated at the
  brainstorming session
• Record the following information on the chart
  provided
• - For each objective, rank and list the
  associated measures/indicators in order of
  importance
• - For each measure, record the method for data
  collection
• - Indicate whether data can be collected by
  systems that currently exist

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References

• Canadian Council on Health Services Accreditation
• Balanced Scorecard- Step by Step Maximizing
  Performance and Maintaining Results- Paul R. Niven