The Balanced Corecard as a Management Tool, Essay Example

Introduction

The dynamic and competitive healthcare sector requires hospitals to deliver enhanced quality of care and service-based flexibility. At the same time, hospitals must reduce their costs. To achieve these goals, hospitals require a different approach and must develop a balanced scorecard which will help them to achieve their strategic goals. In order to support the overall strategic goal, vision, and mission of patient care services, nursing performance improvement plays a critical role. Nursing practice is based on the standards of professional care, and with the aid of patient satisfaction surveys and the balanced scorecard, process improvements are monitored. Other quality-based measures include Nursing Quality National Database Indicators, the review of Sentinel events, and the Standard of Staffing Effectiveness. The following discussion will address the strategic goals and planning of the healthcare system to achieve greater quality service in conjunction with external benchmarks and comparisons (Jepsen, 2015).

Description of Structure of Organization

The organization selected is Patient Care Services and is one of the most successful teaching facilities and trauma centers in a regional metropolitan area of Central Virginia, comprised of 865 hospital beds and outpatient clinics.  In addition, 600 physicians are employed and offer state of the art specialty education and care, including head and spinal cord trauma, cancer treatment, burn healing and organ transplantation. The organization employs 8,000 employees in a variety of positions to support the necessary objectives. The organization is renowned for its breast center program, LVAD Certifications, stroke program, and destination therapy. The American Credentialing Center of Nursing has twice recognized the organization for its efforts with its prestigious Magnet Award.

Hospital Strategic Plan Key Elements

Strategic planning requires a top down and bottom up approach to communication and must trickle down to all staff levels. Employees play a critical role in the process of strategic planning as they provide input with the help of focus groups, feedback and meetings. In order to ensure safety, equality, effectiveness and improvement of patient care, the organization must adopt development and technology tools to facilitate the transformation into a research and clinical practice (Niven, 2011). The organization must aims to restore and preserve health, to cure disease, and to educate the general public. The strategic plan emphasizes service excellence, quality, safety, performance and operations improvement (Kollberg & Elg, 2011). The focus of quality and safety is to reduce the hospital-acquired infections (HAI), Ulcers Hospital Acquired Pressure, patient injuries, and patient falls. The hospital also focuses on the Systems and Consumer Assessment of Healthcare Providers (HCAHPS), which supports the repose time of staff and measuring KPIs.  This reflects areas that involve operations improvements designed to improve productivity, expand professional development, promote evidence-based practice, and transform care at the bedside.

Standards and Accreditation Body for a Quality Management Program

The Joint Commission (TJC) accredited this organization and supports Medicaid and the service regulations of Medicare. The hospital reports and monitors the performance with the help of the Joint Commission and CMS measures of quality. The plan of strategy is based on the metrics of quality, which include injury falls, HAPU and CAUTI (Jakobsen & Lueg, 2014). The indicators of quality enhancement for the goals of nursing are measured with the Nursing National Database Indicators of Quality (NDNQI). Patient satisfaction is measured with the HCAHPS survey.

Organization’s Balanced Scorecard for Quality Measurement    

In healthcare organizations, quality and performance management are very important issues, not just for individuals but also at the national level (Bisbe & Barrubés 2012). The balanced scorecard is used to evaluate competition, cost structure, qualitative treatments, and payer hurdles (Grigoroudis et al., 2012). By adopting the BSC in healthcare organizations, it is very helpful in monitoring performance, and this tool is also useful in improving quality and reducing costs (Bisbe & Barrubés 2012).

Safety, Quality and Service Excellence drive success within the hospital environment.  Establishing goals or targets in accordance with NDNDQI, Magnet, Beacon, etc. offers guidance regarding improvements and how to implement the appropriate strategies to impact score. The table below provides how this organization monitor’s hospital acquired infections (hand hygiene, catheter associated urinary tract infections, and central line bloodstream infections) and set goals for the upcoming fiscal year.

The scorecard listed below provides the FY14 actual score, FY15 organization target goal, and current score for FY15.  The organization will break down the HCAHPS unit to the department level to determine what each department needs to improve the overall score for the hospital.

Access and volume are important as part of the organizational goals to deliver excellent service.  To achieve these goals and an ongoing analysis of discharges, transfers lost, transfers accepted, length of stay and 30 day readmission rates have been selected.  To date, the organization has lost 21 transfers, impacting profits, service, and inverting. Also, the organization must be in good standing with regulatory bodies, including The Joint Commission Gold Start Recognition in Stroke Program, Assist Device/VAD, Palliative Care, and Magnet and Beacon Recognition.

Balanced Scorecard Values and Recommendations for Improvement

The BSC is very useful to the organization and the departments within, and the challenge arises when departments have to provide the results of quality indicators, based on NDNQI recommendations. An organization must examine the scorecard, identify the indicators that require improvement, and work under unit leadership to determine if this will improve scores. The results of the scorecard are categorized by division or by individual units to support goals and guide practice methods (Jeffs et al., 2011).

Measure with respect to Standardized Data Definitions

The scorecard is easy to read and is presented in a table with rows and columns. The data is highlighted with different colors to determine if targets have been met to date (Chen 2011). Green demonstrates that the targets are met, yellow indicates that the targets are partially met and red indicates that the targets are below standards. The BCD allows the organizations to review functions such as customer’s perspective, internal business functions, learning, and innovative perspective and financial perspective (Bisbe & Barrubés 2012).  The figure below provides a summary of the different areas where vision and strategy are most critical:

The CMS and NDNQI are the primary regulatory bodies with which the organization must achieve compliance. Finance, customer satisfaction, internal business processes, and growth opportunity are measured in terms of standardized data. The financial measures emphasizes Value Based Purchasing, to meet or exceed budget Fiscal Year 15: Net Revenue: $453,753,383, Expenses: $338,284,104, Net Income of $65,469,279 and meet the Hours per Patient Day (HPPD) FY15 = 15.63.  It is expected that all nursing units will meet unit-based financial budget for revenue, expenses, and net income and unit based hours per patient day (HPPD).

Customer satisfaction is measured by the hospital’s performance on the HCAHPS.  The primary objective is to improve the percent of adult inpatients who rate the responsiveness of staff as “percent always” on the HCAHPS survey and who outperform the benchmarks for the mean and top box for PRC Loyalty survey.  The responsiveness baseline for FY14 is at 60.77 percent, with a target by FY15 of 62 percent and a current performance FY15 to date of 69.86 percent; the “nurses caring for you when needed” baseline for FY14 is 85.9 percent and the current performance FY15 to date is 87.8 percent; the “explanation of delays” baseline FY14 is 82.2 percent and current performance FY15 to date is 83.9 percent; and “nurses caring for you when needed” baseline for FY14 is 84.7 percent and current performance FY15 to date is 85.8 (59.3 percent). The overall hospital rating is 78.41 percent FY15 to date. Scores that are important to nursing at the health system are nursing communication, responsiveness of staff, pain management and quietness at night.

The internal business process emphasized areas that were below the national benchmark, and also applies to healthcare clinical areas.  Hospital associated infections (HAI), falls, and falls with injury, CAUTI, HAPU, urinary tract infections (UTI’s), major joints, and post-op incision infections are included in this category.  Patient fall rates have decreased 36 percent over the last 6 years.  Overall falls rate declined 1.84 to 1.68 in Fiscal Year (FY) 13 to (FY) 14 per 1000 adjusted patient days.  Patient falls with injury decreased 83 percent over the last 6 years. The reduction of CAUTI goal is not met based on infections/1000 catheter days FY14 is at 3.0 after 6 months with the goal of 2.8 by FY15.  The HAPU prevalence rate decreased from 2.4 percent to 1.4 percent in FY14, and outperformed the target of 2.4 percent, while also surpassing Magnet performance standards. The external standards these metrics are compared to NDNQI and CDC.  The information that is provided in the goal setting process is used to beat or match the means of the 75^thpercentile. The organization’s volume of patients has been on a steady rise over the past 6 months and is well within the lower 700’s when it is budgeted for 625 patient beds.

Growth opportunities include new knowledge, innovations and improvements. The organization is recognized by AACN for having the highest number of Beacon units in the nation, and since 2007, 12 units within the organization have achieved Beacon designation. There are 381 staff in FY14 currently attending school to earn a BSN degree, while there were only 154 employees in FY13. In addition, 86 nurses are enrolled or have completed their masters degree in nursing, five nurse leaders completed their doctoral degrees in nursing and 21 nurses are currently enrolled in a PhD or Doctoral programs.  Certification for all RN’s increased by 12.2 percent and 8.2 percent for direct care RN’s in FY14.  Nursing Directors and Clinicians are 100 percent certified and nurse managers are 97 percent certified. Professional development continues with the Clinical ladder advancement of 13 clinical nurse IV’s and 74 Clinical Nurse III roles, which is an increase of 6 percent to 639 in FY14 (FY13=603).  Research progress continues to grow with 67 studies total, 25 active, 15 developments, and 27 complete, three funded research studies, and seven interprofessional research projects.  There is a new role Nurse Scientist with 31 PhD Scientists and 50 doctorally prepared nurses working throughout the health system.  The nursing evidence-based practice program included seven nurses who completed the two-year program in 2014, and four nurses who are now in their second year.  The Professional Edge new graduate program completed 17 TCAB projects, the baccalaureate nurse residency program presented 37 projects and the evidence-based practice translation committee received 41 submissions in April 2014.  The organation has had 43 publications in FY14, compared to 53 in FY13, and 219 poster and podium presentations, compared to 240 in FY 13.  The transformation of care at the bedside (TCAB) now has 25 units participate in the TCAB process.

An evaluation of goals projection and external benchmarks for the next three years

Strategic plans are prepared to map the course over a three to five year period. These strategic plans must be analyzed on a quarterly basis (Jeffs et al., 2011). As healthcare organizations are unpredictable, leaders should be flexible when considering any plans to change or modify the financial resources because they will have an impact on the local community. Unless conditions change, decisions should be more towards supporting the strategies of the healthcare industry and the future direction of healthcare practice (Chen 2011). The team should be strong and professionally develop to support initiatives to have a positive impact on service, quality and cost pillar indirectly. A strategy should be made in such a way that enables the organization to move forward into the future (Grigoroudis et al., 2012).

Reflection of the Balanced Scorecard Strategic Plan and the Nursing Role

When there is a change in a given system, nurse-sensitive indicators must be evaluated in order to identify the result of financial performance and patient satisfaction (Jeffs et al., 2011). Metric indicators are used to improve progress and to determine what else must be changed to achieve growth in order to provide a way to enable healthcare providers to be accountable for the quality of service and the care that they provide (Chen 2011).

Nursing quality exists at many different levels and requires nurses to ensure that patients have received quality care. This requires the appropriate system of monitoring performance in nursing care. Moreover, it is possible to obtain evidence and to also arrange a unit meeting in order to determine staff engagement and to motivate the nursing staff to be part of the improvement process (Grigoroudis et al., 2012). These efforts will be helpful in demonstrating how the nursing staff is driving its priorities towards improvement.

Conclusion

The balanced scorecard is a tool which provides support in managing and measuring organizational performance. This concept is applicable in healthcare organization; however, the actual challenge is to be able to implement it on a larger scale (Grigoroudis et al., 2012). It is believed that once visions and strategies are clearly defined in healthcare organizations, they are able to choose their own suitable dimensions among ones that currently exist. This will aid in measuring the performance of a healthcare organization as it moves forward (Chen 2011). Nurses, therapists, physicians and others should depend on each other in order to meet the advanced standard of integrative care. This tool has demonstrated a means of reflecting positive outcomes, but also areas that are undesirable. This has enabled the nursing staff to take corrective action in order to maintain a high quality standard of care.

References

Bisbe, J., & Barrubés, J. (2012). The Balanced corecard as a management tool for assessing and monitoring strategy implementation in health care organizations. Revista Española de Cardiología (English Edition), 65(10), 919-927.

Chen, W. T. (2011). The indicators of performance evaluation for nursing home by balanced scorecard.

Grigoroudis, E., Orfanoudaki, E., & Zopounidis, C. (2012). Strategic performance measurement in a healthcare organisation: A multiple criteria approach based on balanced scorecard. Omega, 40(1), 104-119.

Jeffs, L., Merkley, J., Richardson, S., Eli, J., & McAllister, M. (2011). Using a nursing balanced scorecard approach to measure and optimize nursing performance. Nursing Leadership (Toronto, Ont.), 24(1), 47-58.