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Balanced Scorecard Scorecards and Performance Measures

Balanced Scorecard Scorecards and Performance Measures. Funded by the Office of Rural Health and Washington’s Department of Health. On the phone…. Michael Pugh. 20 Years CEO experience in hospitals, health systems and managed care CEO of United General Hospital, Sedro Woolley, WA 1979-1984

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Balanced Scorecard Scorecards and Performance Measures

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  1. Balanced ScorecardScorecards and Performance Measures Funded by the Office of Rural Health and Washington’s Department of Health

  2. On the phone… Michael Pugh • 20 Years CEO experience in hospitals, health systems and managed care • CEO of United General Hospital, Sedro Woolley, WA 1979-1984 • Senior Faculty Member IHI • Consulting work focuses on improving quality and performance

  3. How Does Your Board Answer the Questions… How good is our hospital? Are we achieving what we need to achieve? How do we know?

  4. Another Way to Think About How Good… • What are you willing to promise patients about medication safety at your hospital? • What are you willing to promise patients about the use of evidence-based medicine in your hospital and clinics? • What are you willing to promise patients about the level of care and service that will be provided? • What are you willing to promise the community about access and cost?

  5. How Good? • What level of medication error is acceptable if you are the patient? • How do you pick the patient that is not to receive evidence-based treatment? • How do you decide which patient should have a surgical site infection? • How do you explain to your mother that it is perfectly acceptable to wait in the ER for 8 hours and receive a bill for $3500.00?

  6. Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin Reduce Surgical Complications by reliably implementing all of the changes in care recommended by SCIP, the Surgical Care Improvement Project (www.medqic.org/scip) Prevent Pressure Ulcers... by reliably using science-based guidelines for their prevention

  7. Reduce Methicillin-Resistant Staphylococcus Aureus (MRSA) infection by reliably implementing scientifically proven infection control practices Deliver Reliable, Evidence-Based Care for Congestive Heart Failure to avoid readmissions Get Boards on Board … by defining and spreading the best-known leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care

  8. Building Stronger Health Care Boards Basic Governance Functions • Keeper of the Mission • Set Direction and Expectations • Monitor Progress • Hire and Evaluate the CEO • Represent the interests of the community

  9. Financial Operating Budgets and Targets Cash Capital Expenditures Financial Integrity--Audits Compliance Legal and Regulatory Board Policy Risk Management Strategic Progress on implementation of key strategies Results Quality Patient Satisfaction Clinical Care Performance Indicators Patient and Employee Safety Scorecards are Tools for Monitoring Progress and Setting Expectations

  10. Why Use Scorecards and Performance Measures? • You should be able to look at what the leadership of an organization measures and determine the organization’s priorities and strategy • In God we Trust, all else bring data….

  11. Balanced Scorecards Drive Operating Strategies • Clarify/Translate • Vision and Strategy • consensus • Communicating and • Linking • goals • performance measures • Strategic Feedback • /Learning • articulating vision • strategic feedback • review and learning Balanced Scorecard • Planning and Target • Setting • align w/ strategy • allocate resources Adapted from The Balanced Scorecard Kaplan & Norton Adapted from The Balanced Scorecard Kaplan & Norton

  12. Seven Leadership Leverage Points for Driving Great Performance* • Set measured system-level aims and oversee their achievement at the Board level • Align aims, measures and strategies in a leadership learning system • Channel leadership attention to aims • Engage an effective and committed executive team • Engage the CFO in this work • Engage with physicians • Build deep improvement capability *www.ihi.org Reinertsen, Pugh, Bisognano 2006

  13. Leverage Point 1: Establish system level measures • Set measured system-level aims and oversee their achievement at the Board level • Owned by the governing board • Collectively, the measures answer the question: How good are we? • Transparent—everyone in the organization should know the Key Measures

  14. Mortality Readmission Rates Patient Experience % of Patients Receiving Care According to the Evidence Employee Satisfaction or Engagement Cost per Discharge Days Cash on Hand Patient Safety Access What Should Be On the Hospital Board’s Performance Scorecard? Board performance measures should at minimum include expected aims and results for:

  15. IHI Proposed System Level Measures

  16. IHI 2007 Critical Questions For Creating Alignment Between Desired Results and Quality Projects

  17. IHI 2007 Aligned Operating Strategies and Quality Projects Drive Desired Results

  18. IHI 2007 Process & Operational Measures Organizational Performance Measures Strategic Measures/Drivers An Organization’s Measurement System Should Be Linked to Drive Desired Results

  19. Measure what is important Review every meeting Use topic specific scorecards to drill down at committee level (finance, strategy & planning, quality, safety, etc.) Use Simple Formats Set all-or-none target levels for clinical care and safety measures (100% or 0%) Avoid using averages; use percentiles measured against standards Avoid color coding to low expectations Data graphed over time is the most powerful format Simple Rules for Board Level Scorecards and Dashboards

  20. Simple, and sometimes too simple Color coding without numbers can mislead Tendency is to assume that only the “red” blocks need attention If used, boards need to frequently ask how the targets are set Color Coded DashboardsOnly As Good As Your Targets

  21. Report to the Board Quality Committee “Our MI Core Indicators were greatly improved last quarter. Only one EBC requires corrective action.” The Case For All-or-None Measurement Governance Question: “What % of Patients Got the Right Care?”

  22. The Case For All-or-None MeasuresOnly 30% of Patients Received the Right Care* *Right Care defined as receiving all of the required EBC elements that the patient was eligible for

  23. Door to Intervention time proven to be critical to Heart Attack outcomes Standard=30 minutes from presentation to (Thrombolytics or 90 minutes to Angioplasty) Quality Committee Report “Our data indicates that we are exceeding the national standard. Our average time for thrombolytics is 29.5 minutes.” The Case for Measuring Against Standards/Expectations Great Report or Not?

  24. Not. What about the 25% of patients with delayed care? Average = 29.5 Minutes 30 Minute Standard 25% of All Patients Beyond the Standard

  25. Anywhere HospitalHeart Surgery Program Board Report “Compared to January of last year, our heart surgery mortality has decreased from 5.9% to 1.1% Monthly Mortality 5.9% Jan 05 Should this be a cause for celebration? 1.1% Jan 06

  26. When do you want to have your Heart Surgery? St. Elsewhere Monthly Heart Surgery Mortality 5.9% AVG = 3.5% 1.1%

  27. An Oregon Hospital’s Proposed Governance Scorecard (example)

  28. Bronson 2004 Scorecard

  29. Sample Board Dashboard Format

  30. Summary • Every hospital board should adopt a set of high level performance measures and targets used to define expectations and track performance • Content and systematic review is more important than format • Use All-or-None Targets for Key Clinical Measures • Asking good questions the key to successful governance

  31. Michael Pugh Pugh Ettinger McCarthy Associates, LLC P.O. Box 8298 Pueblo, Colorado 81008 719 542-2433 Direct 719 542-2564 Fax mpugh@verismasystems.com Institute for Healthcare Improvement www.ihi.org Center for Healthcare Governance www.americangovernance.com For More Information These slides may be used by others only in their existing format with proper attribution/service marks of Pugh Ettinger McCarthy Associates, IHI and the Center for Healthcare Governance

  32. Questions/Comments?

  33. Future WSHA & AWPHD Programs Governing Board Orientation & Education May 1, 2007 12-1 PM

  34. Future WSHA & AWPHD Programs CEO & Trustee Quality Summit SeaTac Hilton May 31, 2007 8 AM-5 PM • Facilitated by Dr. James Reinertsen

  35. Future WSHA & AWPHD Programs Rural Hospital Summer Workshop Campbell’s Resort Chelan, WA June 25-27, 2007 • Dennis Stillman: Board Self-Evaluation • Brad Berg: Compliance Planning • Jan Jennings: Building Better Boards and Managing a Hospital in the 21st Century

  36. Future WSHA & AWPHD Programs WSHA 75th Annual Meeting Bell Harbor International Conference Center Seattle, WA October 11, 2007 1:00-3:00 PM • Mock Board Meeting – Relationships, Learning, Decision-making, and Behavior: Larry Walker, playwright

  37. Thank you for participating! Please fill out the evaluation.

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