Dashboards in the Healthcare Sector

1. Dashboards in the Healthcare Sector Howard Gitlow, Ph.D. Steve Ullmann, Ph.D. Amy Zuo, M.B.A. University of Miami School of Business Administration 305 284 4296 hgitlow@miami.edu www.howardgitlow.com

2. Traditional Management in Healthcare • Management by Objective • Performance Appraisal

3. Traditional Management in Healthcare: Management by Objective • Management by Objectives (MBO) is a process of negotiating periodic performance objectives between superiors and subordinates in an effort to cascade top management’s wishes throughout an organization. Frequently, objectives (MBOs) are set using numeric targets with deadlines for key process metrics, or just deadlines for projects.

4. Traditional Management in Healthcare: Management by Objective • Management Information Systems (MIS) are needed to operationally define and measure key metrics in respect to their MBOs. MIS usually track key metrics over time, for example, monthly or yearly, or comparatively, for example, “this month this year with this month last year,” or “this quarter this year with this quarter last year.” (Drucker, Peter F., "The Practice of Management", 1954. ISBN 0060110953)

5. Traditional Management in Healthcare: Management by Objective • An MBO type dashboard is a tool used by policy makers and managers to clarify and assign accountability and responsibility for the key objectives needed to steer an organization toward its mission statement. • Dashboards are used to deploy the mission statement throughout the levels of a healthcare system, from top to bottom, through the development of a cascading and interlocking set of key objectives as measured through numeric targets or deadlines.

6. Traditional Management in Healthcare: Management by Objective • There are many variants of MBO type dashboards which are used in a wide variety of applications ranging from manufacturing, to service, to healthcare, to government, to education. However, all of these applications contain several similarities. First, all of the applications display a drill-down system of key objectives. Second, all of the applications use data on key metrics to determine the status of each key objective. However, these systems do not usually consider the managerial implications of an automated MBO style of management.

7. Traditional Management in Healthcare: Management by Objective Examples hyperlink Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

8. Traditional Management in Healthcare: Performance Appraisal • Performance Appraisal Systems (P.A.S.s) are the vehicles used to assign accountability and responsibility to the individual responsible for a process that generates a key metric subjected to an MBO. The MBO-PAS package is the extrinsic motivational hammer used to enforce MBOs, or in other words, top management’s will. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

9. Traditional Management in Healthcare: Performance Appraisal • Employees can be monitored in respect to many types of MBOs, for example, Quality MBOs, Quantity MBOs, Cost MBOs, or Time based MBOs. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

10. Traditional Management in Healthcare: Performance Appraisal • Examples of Quality MBOs are: Percentage of defective product produced in the Miami plant in the Second Quarter of 2007 <10%, or the Number of warranty claims in the Miami plant as of December 31, 2007 < 2%. • Examples of Quantity MBOs are: Number of Sales Calls Made in the Miami Office by Salesperson X at the end of the first quarter of 2007 > 650 sales calls, or Number of Records Processed in the Miami Office at the end of the first quarter of 2007 > 25,000 records. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

11. Traditional Management in Healthcare: Performance Appraisal • Examples of Cost MBOs are: Raw Materials Expense in the Miami plant in the Second Quarter of 2007 < $150,000, or Revenue from Product X in Florida in the Third Quarter of 2007 > $1,000,000. • Examples of Time Based MBOs are: The computer system in the Red River plant must be fully operational before December 31, 2007, or The Ad campaign for Product Y must be submitted to the client no later than 5:00 pm on June 15, 2007. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

12. Dashboard Management in Healthcare • Macro Model (Dashboards) (2) Micro Model (DMAIC, DMAVD, Lean) (3) Management Model (Deming’s SoPK) Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

13. Mission Statement: -------------------------------------------------------------------------- President Direct Reports Key Objectives Key Indicators Area Objectives Area Indicators Potential Tasks and Projects Key objectives must be achieved to attain the mission statement. One or more key indicators show progress toward each business objective. Area objectives are established to move each business indicator in the proper direction. One or more area indicators show progress toward each area objective. Projects are used to improve or innovate processes to move area indicators in the proper direction. Macro Model (Dashboards) Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

14. Example of a Dashboard Cascading System of Mission statements Business School of the University of Miami Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

15. Example of a Dashboard Cascading System of Key Objectives and Key Indicators Business School of the University of Miami Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

16. Partial Dashboard of Health Sector Management & PolicyUniversity of Miami Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

17. Partial Dashboard of Health Sector Management & PolicyUniversity of Miami Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

18. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Part of Marsha’s Diary of Unassertive behavior for Two Weeks Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

19. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Daily Count of Number of Unassertive Episodes It shows the number of unassertive episodes per day taken from Table 22 before a change to Marsha’s behavioral response to unassertive episodes Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

20. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Marsha’s c-Chart of Unassertive Behavior per Day Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

21. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Marsha’s Pareto Diagram of Unassertive Behavior Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

22. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Marsha’s Before and After c-Chart Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

23. Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”) Marsha’s After Pareto Diagram Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

24. Benefits of Dashboard Management Healthcare Administration program managers use a dashboard at monthly operations review meetings for several purposes. • First, they use dashboards to clarify mission statements and key objectives, and accountability for them, among all personnel and areas. • Second, they use dashboards to promote statistical thinking about reacting to fluctuations in key indicators. For example, is the number of applicants to the healthcare administration program for last year due to a special or common cause of variation in the admissions process. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

25. Benefits of Dashboard Management • Third, managers use dashboards to clarify and reduce the perception that most of the daily crises (called “helter skelter” items) requiring immediate and special attention are really special cases of known key objectives. A manager’s ability to recognize “helter skelter” items as special cases of key objectives reduces the amount of tension involved in dealing with a multitude of crises “du jour.” • Fourth, managers use dashboards to develop and test hypotheses concerning potential changes to processes. • Fifth, mangers can use dashboards to ensure the routine and regular updating of key indicators. Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

26. Micro Model (Projects) • Visual Management (for example, the ‘5Ss”) • SDSA/PDSA • Six Sigma • Improvement model (DMAIC) • Invention and Innovation model (DMADV) • Lean Thinking (the Toyota Production System) Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

27. Management Model (Deming’s System of Profound Knowledge) • Purpose: Pursue the organizational mission through the promotion of “joy at work.” • Assumptions (needed for a data based system of management): • Optimize the whole system, not just your component of the system • Improve the process to get results, do not just demand results • Cooperate, do not compete, if the aim of the system is not to win • Balance extrinsic and intrinsic motivators, do not rely only on extrinsic motivators • The above assumptions form an integrated system and cannot be separate Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008