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Applying Balanced Scorecard
A Zulekha Hospital Case study
Dr Kishan Pakkal
Director -Operations
&
Gururaj Rai ,MHA
Business Development Manager
Presented in Thailand 2006 –Healthcare Conference
Today’s Presentation
• Zulekha Healthcare Group Overview
• Beginnings, evolution of BSC process
• A new era of accountability
• To Judge the results
Dubai
UAE
Zulekha Healthcare Group
OverviewHospitals
• Zulekha Hospital – Sharjah – 60 beds
• Zulekha Hospital – Dubai - 75 beds
Medical Centres• Zulekha Medical Centre - Qusais, Dubai• Zulekha Medical Centre - Al Wahda, Sharjah• Zulekha Medical Centre - Dhaid, Sharjah
Pharmacies• Pharmacy - Al Rafea, Qusais, Dubai• Pharmacy - Zulekha Hospital, Sharjah• Pharmacy - Zulekha Hospital, Dubai
Overview of Zulekha Hospital’s
care program
• Popular Healthcare units at Dubai and
Sharjah
• Notable specialty departments – Gynaec
and Laparoscopy, Invasive Cardiology,
Orthopedics and Knee replacement
• ISO Certification and currently in line with
JCI accreditation.
Strategic Planning so far
• As an healthcare provider we are striving
for Quality Care through International
accreditations
Resulted In….
• A very comprehensive plan being
developed
• Too many Indicators, Contained no real
accountability
• Anyone who had an idea got their item in
the plan
• Indicators linked to performance and not to
strategy
Other factors
• Changes in the external Healthcare
environment, such as the Healthcare
Quality drive by Health Authority
Initial Progress
• Progress
Began tracking Hospital performance on various deployed quality indicators.
• Pitfalls
Functioned primarily as a kind of isolated meter, with no connectivity of the measures.
Rather than a new way of running the Hospital, It was one more thing to do every month
The Problem..
• We were trying to work with a performance
measurement tool in advance of crafting a
focused business strategy.
A New Approach Taken
• Decision was made to take a different approach to strategy development.
• We viewed ourselves as a business and identified our margin, market opportunities, which shaped the financial dimension of our strategy map.
• This increased margin opportunity would then allow us to reinvest in the non-growth areas of the organisation
• Pilot study has been deployed by
implementing Balanced Score Card on
Radiology Department to study its efficacy
Balanced Score Card
Balanced score card
• Balanced Scorecard is simply a concise report
featuring a set of measures that relate to the
performance of an organization.
• BSC gives management a framework or
language which would communicate the
organisation's mission and strategy, while using
measurement to inspire employees to achieve
specified outcomes.
• Imagine flying a Boeing just with one
meter – it would be disastrous.
• BSC advocates the same philosophy, that
Organization should be looked beyond
Financial meter.
• It focuses not only on financial areas that
were of significant importance traditionally
but also on Internal process, customer and
learning and growth
The Balanced Score Card Mantra
• Organizatons should clearly communicate
their vision and strategy to all levels of the
management and look at critical success
measures to achieve the goal.
• Real success just not depends on
achieving financial goals.
• How did we apply Balanced score Card ??
First, understanding our Customers
Value propositions to provide clarity in
strategy
BASIC CARE
PATIENTS
SPECIALITY CARE
PATIENTSINSURANCE CO.
CORPORATES
CUSTOMER
INTIMACY
BRAND &
TECHNOLOGY
LEADERSHIP
OPERATIONAL
EXCELLENCE
Hospital viewed as a business unit
Balanced Score Card Approach
To financially sustain our Mission, on what must we focus ?
To achieve our Vision, how should we appear to our customers?
To satisfy our customers at which operational processes must we excel ?
How will we sustain our ability to change and improve ?
FINANCIAL
CUSTOMER
INTERNAL
LEARNING & GROWTH
Vision: To be the most efficient, competent and courteous providers of
comprehensive healthcare in the world.”
Mission : “To provide easy accessibility to high quality healthcare”
Strategy Map - Objectives
FINANCIAL
To financially sustain our Mission, on what must we focus ?
CUSTOMER
To achieve our Vision, how should we appear to our customers?
INTERNAL
To satisfy our customers at which operational processes must we excel ?
LEARNING & GROWTH
How will we sustain our ability to change and improve ?
Market opportunities Deliver Cost Efficient Care
Basic Care Patients Specialty Care Patients Referring Physicians Insurance Co.
Provide Outstanding Customer Service Clinical Excellence Strive for Operational Excellence
Instill a climate for change Implement Technology Skill and Competency Development
Build a strong Financial Base to implement the GROWTH strategy of the Hospital
Strategy Map - Measures
FINANCIAL
Build a strong Financial Base to implement the GROWTH strategy of the Hospital
Market Opportunities
CUSTOMER
Excellent service and
Personal relationships
Leading technology
Leading edge expertise
Low cost service and
Innovative Programs
Easy Access On Time Service Research & Clinical practice mgmt Maximize Staff efficiency
INTERNAL
Involvement & commitment to the
missionImplement technology to
support internal processDevelop critical staffing resource plans
Develop a Quality Mindset
LEARNING & GROWTH
Corporate level Strategy MapVision: To be the most efficient, competent and courteous
providers of comprehensive healthcare in the world.”
FINANCIAL
CUSTOMER
INTERNAL
LEARNING & GROWTH
Growth Deliver Cost Efficient Care
Basic Care Patients
Excellent service and
Personal relationships
Specialty Care Patients
Leading technology
Referring Physicians
Leading edge expertise
Insurance Co.
Low cost service and
Innovative Programs
Provide Outstanding
Customer Service Develop Clinical Excellence Strive for Operational Excellence
Easy Access On Time Service Research & Clinical practice mgmt Maximize Staff efficiency
Instill a climate for change Implement Technology Skill and Competency Development
Involvement & commitment to the
mission
Implement technology to
support internal process
Develop critical staffing resource plans
Develop a Quality Mindset
Build a strong Financial Base to implement the GROWTH strategy of the Hospital
Market
Opportunities
Balanced Score Card Initiatives
Implement Growth ROI on growth initiatives
Market Share
Implemented growth strategies in
focused areas -
Cardiology
Orthopedics
Radiology
Operating Cost
% compliance to formulary
Supply expense
Costing on surgeries
Supply standardisation and expense
reduction
Formulary Expansion
Care delivery model
Standardized Inventory system
Basic Care patients
Specialty Care Patients
Referring Physicians
Insurance/ Corporate
Implement Quality Plans to improve
Overall Patient satisfaction
Implement Marketing plan
Objectives Measures Initiatives Targets
Fin
an
cia
lC
us
tom
er
Deliver Cost Efficient
Care
Excellent service and
Personal relationships
Leading technology
Leading edge expertise
Low cost service and
Innovative Programs
Provide Outstanding
Customer Service
Waiting Time
Telephone access
Clinics with open access
Feedback and satisfaction
Implemented growth strategies in
focused areas -
Cardiology
Orthopedics
Radiology
Clinical Depts. With quality
plan
Patients on approved
clinical pathways
Research in targeted
growth depts.
Supply standardisation and expense
reduction
Formulary Expansion
Care delivery model
Standardized Inventory system
Bad debt / receivable
Cost reduction
Staff competency and
efficiency
Process Innovation
Quality dept. being initiated
Cost areas being mapped
HR review and assessment
IT integration
Inte
rnal
Develop Clinical
Excellence
Strive for
Operational
Excellence
Objectives Measures Initiatives Targets
Balanced Score Card Initiatives
Climate for Change and
commitment
Idea review
Employee/physician
satisfaction
Staff recognition and
retention
Open door policy for ideas and
innovation
Satisfaction survey
Organisation wide program
regarding commitment & pride
Technology Deployment of technology
in key patient and
operational areas
Process review – time and
motion study
Deployment for patient
education
Implement to integrate E
Medical record program
Skill and competency
development
Staffing positions in
targeted growth areas
Performance to training
and Quality education
Implement staffing and
recruitment
Implement quality education and
accountability model
Learn
ing
&
Gro
wth
Objectives Measures Initiatives Targets
Balanced Score Card Initiatives
Cascading the score card methodology to
Radiology Department
Vision: To be the most efficient, competent and courteous
providers of comprehensive healthcare in the world.”
Radiology - Strategy Map
Maximise Revenue
FINANCIAL
PERSPECTIVE
Growth Opportunities Increased sales
CUSTOMER
PERSPECTIVE Offer full range of
imaging services
Provide on time
service
Customer satisfaction
and enhancement
INTERNAL
PERSPECTIVE
Technology Leadership & Operational Excellence
Quality Reporting Create state of the art
Information system -PACS
On time Reporting Reducing Equipment Break down Reducing Film Wastage
Patient Education
Operational Processes
A Motivated and Prepared Workforce
LEARNING & GROWTH
PERSPECTIVE Recruit & Retain Professional &
Technical Staff
Invest in Continuous Education
Develop Communication Plan
Staff satisfaction and feedback
A New Era of Accountability
• Departmental meetings
- Performance, Strategic directions
• All Meetings use the framework of the
strategy map and score card to
communicate priorities and report on
performance
• Monthly results reported to the whole
organization via the intranet
A New Era of Accountability
A New Era of Accountability
• Monthly Executive Leadership Strategic
Operating Review Meetings :
- Review monthly performance indicators
- Majority of the meeting spent discussing
strategic issues within the context of the
strategy Map
• Director Level bi-weekly initiative progress
meetings
How is Balanced Score Card
Helping us ?
• A complete paradigm shift for developing
& implementing strategy
• Increased executive, management and
physician/staff accountability, but now with
clearly defined targets.
• Aligning the entire organisation through a
common set of well understood objectives.
• Consistency of message
• Improve patient satisfaction
• Effective communication tool for
governance, administration, management
and employees.
Finally…
Quality is everyone’s job,
and we need to do it right .
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