Creating a Hospital Patient Safety Program by yaofenjin


									The Evolution of Balanced Scorecard
        Reporting at BWH

        Michael Gustafson, MD, MBA
             Sue Schade, MBA

           September 20th, 2002

•   Describe the Balanced Scorecard framework
•   Describe BWH approach
•   Provide high level solution overview
•   Share lessons learned
            Center for Clinical Excellence

                              Center for Clinical Excellence

   Performance             Performance             Patient Safety           Hospital & Dept
   Improvement         Measurement & Analysis          Team                 Quality Programs

Service-Line Teams       Internal Reporting     "Cultural" Initiatives   JCAHO/ORYX Program
Service Line Support   External Benchmarking      Event Analysis         Partners Quality Agenda
  Special Projects        Analytic Support      Action Item Support        QA Benchmarking
                        Balanced Scorecard       Medication Safety         Dept Quality Plans
Performance Measurement & Analysis Group

• Mission Statement….
  • ”become a central decision support resource for leadership,
    managers, and clinical caregivers by facilitating an
    understanding of critical information needed to improve the
    processes and outcomes of care on a daily basis.”
• Goals …
  • Performance Reporting Aligned with Strategic Goals
  • Internal Consultants for Data & Analytic Questions
  • Coordination of Data Analyses across Depts
  • Healthcare Data Management Expertise
  • Data & Analysis “Quality Assurance”
        What is the Balanced Scorecard?
• A performance measurement & management framework to
  define, align and communicate strategy effectiveness at all
  levels of an organization
• Developed by Kaplan & Norton at HBS in 1992
  (“The BSC - Measures that Drive Performance”; HBR)
• Using only financial or tangible asset measures to judge
  performance is not enough….need to consider other factors
  such as quality, customer satisfaction, employee
  development, innovation, etc.
• Mirrors thought process behind “The Service-Profit Chain”
• 10 year results reviewed by Kaplan & Norton in 2001
  (“The Strategy Focused Organization: How BSC Companies
  Thrive in the New Business Environment”; HBR)
     Strategy Map - Balanced Perspectives

• Strategy maps incorporate major institutional goals from 4
  different, “balanced” perspectives:
   – Financial = Financial Health
   – Customer/Outside = Patients & Community
   – Internal/Business Processes = Quality & Efficiency of Care
   – Knowledge & Growth = Employee Development & Clinical
              Evolution of BSC at BWH:

•   Concept explored January 2000
•   Leadership buy-in, agreement to explore June 2000
•   Software RFP August 2000
•   Vendor Reviews/Selection Dec 2000
•   Partnership Contract finalized May 2001
•   Executive Sponsors, Project Plan finalized June 2001
•   Strategy Maps and Measures designed July-August 2001
•   “Start-up” Failure October 2001
•   SAS 4-Year Partnership finalized January 2002
•   9 month project plan:
    – Surgery scorecards implemented by Sept/Oct 2002
    – Nursing scorecards implemented by Nov/Dec 2002
    – includes knowledge transfer, and development of training strategies
     BSC Hierarchy Planned for BWH

                 Executive Strategy

Surgical Objectives Nursing Objectives   Other Depts

  Key Surgical        Key Nursing
                                         Key Indicators
  Performance         Performance
                                         for Each Dept.
   Indicators          Indicators
 BSC Cascading Structure for Pilot Areas

                  Executive Scorecard           Finance

                                Nursing Services
Surgical Services
                                Nursing Directors
 Surgical Depts
                                Nurse Managers
Surgical Divisions
                              Nursing Cost Centers
                                 Nursing PODs
          BSC Project Implementation Schedule
                    Milestones                          Expected      Actual       Status
                                                       Completion   Completion

Hardware/Software Set-up                                 2/22/02      2/22/02    Complete
Scorecard Design and Prototype                           3/15/02      3/15/02    Complete
SAS Data Warehouse Design                                3/26/02      4/11/02    Complete

Design Finance Scorecards                                3/1/02       3/1/02     Complete
Deliver Final Specifications for Finance Scorecards      3/1/02       3/1/02     Complete
Build Finance Scorecards                                 4/1/02       4/1/02     Complete
Install/Review Production Scorecards                     5/28/02      6/11/02    Complete
Roll-out Finance Scorecards1                            10/17/02                 Underway

Design Surgical Scorecards                              3/28/02       3/28/02    Complete
Deliver Final Specifications for Surgical Scorecards    3/28/02       3/28/02    Complete
Build Surgical Scorecards                               6/17/02       7/5/02     Complete
Install/Review Production Scorecards                     7/6/02                  Underway
Roll-out Surgical Scorecards                            Sept/Oct                 Scheduled

Design Nursing Scorecards                                7/8/02       7/8/02     Complete
Deliver Final Specifications for Nursing Scorecards      8/9/02                  Underway
Build Nursing Scorecards                                10/11/02                 Scheduled
Install/Review Production Scorecards                     11/1/02                 Scheduled
Roll-out Nursing Scorecards                             Nov/Dec                  Scheduled
          Resources and Project Organization
• Resources
   –   PMAG - project management and design
   –   Information Systems - infrastructure and external feeds
   –   SAS - implementation services and training
   –   Ongoing support and maintenance with existing staff in PMAG and IS

• Project Organization
   – Executive sponsorship
   – Oversight committee
   – Core project team - BWH and SAS
       Steps in Implementing a Dept Scorecard
•   Establish an Executive Champion (VP)
•   Select and educate a BSC development group
•   Develop “strategy map” and strategic goals for dept
•   Inventory/brainstorm all potential measures for each goal
•   Determine which measures exist or can be captured
•   Rationalize list of measures
•   Develop detailed measure documentation
•   Develop data extracts
•   Develop “report” specifications
•   Develop BSC reporting hierarchy & security access
•   Data warehouse, scorecard, measure, report programming
•   Scorecard QA (reconciliation against source systems & reports)
•   Roll-out, education, and training
 Why the SAS BSC Software Solution at BWH?

• Extensive RFP process yielded SAS product as market leader
• Certified by BSC Collaborative
• Few healthcare institutions have attempted this….national
  leadership opportunity as the SAS-AMC reference client
• SAS CEO’s commitment to creating “showcase” BWH program
• Exceptional corporate stability and reputation (largest private
  software company in the world)
• Exceptional SAS BSC & Healthcare content expertise
• Underlying data warehouse structure easily accommodates
  automated feeds from existing BWH data sources (TSI, CHASE,
  Press Ganey, MS Access, MS Excel, etc.)
• Associated SAS analytic tools included for internal PMAG use
• System can be “owned” by BWH after implementation
 Integrating the Balanced
Scorecard Framework into
  Strategic Management
       BSC - Level 1 Successful Outcomes
         (Reporting & Decision Support Tool)
• Strategy maps incorporate major institutional goals from 4
  different, “balanced” perspectives:
   – Financial Health
   – Patients & Community
   – Quality & Efficiency of Care
   – Employee Development & Clinical Innovation
• Measures selected for each goal are meaningful
• “Balance” of tangible and intangible measures
• “Balance” of outcome (lag) & process measures
• Multiple reporting efforts consolidated in a “balanced” way
• Access to and use of critical data is improved
      BSC - Level 2 Successful Outcomes
           (Performance Management Tool)

• VP’s, Chiefs, Managers, providers access BSC regularly to help
  manage their areas of accountability, and/or assess their own
• VP’s, Chiefs, etc. use in one-on-one and mgmt meetings with
  staff to discuss problem areas needing attention
• Linkages between quality/safety, customer, & employee results
  to overall financial outcomes start to become apparent
• Correlations (+ and -) between measure trends can be seen and
  acted on (e.g., staffing productivity, errors, satisfaction)
• Adverse measure trends generate requests for more drill-down
  and analysis to help guide corrective steps
• Convert “data-rich” BWH culture into “focus on information”
          BSC - Level 3 Successful Outcomes
         (Strategic Leadership & Management Tool)

• Board and Executive Leadership adopt BSC framework as part of
  strategy formulation and hospital-wide communication plan
   – BSC has the potential to translate equally well to clinical care providers
     (MD’s, RN’s, etc), leadership, managers, & board members
• Executive strategy map and measures reviewed at least annually and
  revised to capture new priorities
• Key Executive goals and measures cascade throughout all lower-
  level strategy maps and scorecards
• Review of BSC goals and measure performance incorporated into
  leadership meetings
• Research and education goals/measures incorporated along side
  strong set of clinical indicators
• Equal accountability mandated for goals in all 4 quadrants
              BSC Lessons Learned to Date
• Executive sponsorship and buy-in was key to getting project off
  the ground and funded for 4 years
• VP sponsors for pilot areas were true advocates
   – each believed in usefulness of scorecards for managing their areas, but
     were struggling with paper-based, manual solutions
• All executive leaders look forward to consolidation of existing
  reports and management data into “one place”
• A data warehouse that can accept key healthcare feeds, with
  minimal internal programming, is essential
• Limiting # of measures is critical, but difficult
• Supporting reports and level of drill-down is designed to answer
  first question a user might have about a trend - not to replace
  source systems/reports or more sophisticated root-cause analyses
• BSC framework has been easy to explain and well-accepted

Michael Gustafson -
Sue Schade -
Ken Finn -

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