balanced scorecard workshop presentation
TRANSCRIPT
Date: Thursday, February 20, 2014
Hosted by: HNHB Community Leaders Council
This workshop is hosted by the HNHB Community Leaders Council
Council is co-chaired by Brother Richard MacPhee, Executive Director, Good Shepherd, and Melody Miles, CEO, HNHB CCAC
We’re pleased to have Nathan Doidge and Matthew Ramenaden from Health Quality Ontario with us today to lead us in a workshop regarding Balanced Scorecards
Beth Beader, Executive Director, North Hamilton Community Health Centre
Mary Burnett, CEO, Dementia Alliance
Mary Lee Bull, Regional Independent Living Manager, Ontario March of Dimes
Jan Narduzzi, Executive Director, Brain Injury Services
Tim Siemens, Executive Director,Tabor Manor
Marg Pattillo, Administrator, Creek Way Village
Brother Richard MacPhee, Executive Director, Good Shepherd
Steve Sherrer, CEO, AbleLiving Services Inc.
Donna Cripps, CEO, HNHB LHIN
Melody Miles, CEO, HNHB CCAC
Terry McCarthy, CEO, Hamilton Family Health Team
Marcel Castonguay, Executive Director, Centre de santé communautaire Hamilton/Niagara
Pamela Blackwell, Executive Director, McNally House
Lori Santelli, Executive Director, Adult Recreation Therapy Centre (ARTC)
Trish Balardo, Executive Director, Seniors Activation Maintenance Program
Karen Candy, Executive Director, The Carpenter Hospice
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Balanced Scorecard Workshop Nathan Doidge & Matthew Ramenaden
February 20, 2014
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Workshop Outline
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Module Time
Introduction 09:00 - 09:15
Theory Burst #1: Introduction to Balanced Scorecards 09:15 - 09:30
Practice: Group Exercise 09:30 - 10:00
Practice: Group Discussion 10:00 - 10:15
Coffee break 10:15 - 10:30
Theory Burst #2: Balanced Scorecards in Healthcare 10:30 - 10:45
Practice: Group Exercise & Group Discussion 10:45 - 11:15
Practice: Peer Discussion 11:15 - 11:45
Wrap-up 11:45 - 12:00
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About Health Quality Ontario
www.HQOntario.ca
• HQO works in partnership with Ontario’s health care
system to support a better experience of care, better
outcomes for Ontarians and better value for money.
• HQO’s legislated mandate under the Excellent Care for All
Act, 2010 is to:
– monitor and report to the people of Ontario on the
quality of their health care system
– support continuous quality improvement, and
– promote health care that is supported by the best
available scientific evidence
• HQO is an arms-length agency of the Ontario government.
Visit www.hqontario.ca for more information.
www.HQOntario.ca
Balanced Scorecard Workshop Theory Burst #1: Introduction to Balanced Scorecards (BSCs)
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Learning Objectives: Module 1
At the end of the module, participants will be able to
answer:
• What problem are Balanced Scorecards trying to solve?
• What are the benefits of using Balanced Scorecards?
• What are SMART objectives?
• What are key considerations when selecting measures?
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Scenario
• It’s 1980 and you are the CEO of Smith
Corona, one of the largest typewriter
manufacturers in the world
• The organization is celebrating its 94th
year in business and once again has
healthy profits
• All of your performance reports look
great: revenues are up & expenses are
under control
• Based on these reports, your Board
tells you to grow: Open 10 new
factories in the next 5 years!
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Background
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Staff
Attrition
Unhappy
Clients
Supply
Shortages
Antiquated
Technology
Poorly
Trained
Employees
Financial
Health
• Historically, performance
reporting was focused on
financial measures alone
• General assumption: How an
organization performed in the
past is how they’ll perform in
the future
• Problem: Quickly changing
technology and business
environments make the past a
very poor predictor of the future
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A Balanced View
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Financial
• How do we look to shareholders?
Customer
• How satisfied are our customers?
Internal Process
• How efficient are we?
Learning & Growth
• How can we continue to improve?
• Balanced Scorecards (BSC)
allow companies to track
financial results and
simultaneously monitor progress
in building capabilities needed
for future growth
• BSCs produce a balance
between:
– How the organization sees
itself and how others see it
– Short run and long run
– Internal and external
– Leading and lagging
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Scorecard Illustration: Telephone Company
Objective Measure(s) Target Initiatives
What are we specifically trying to
achieve in each perspective?
How will be measure our progress in
achieving the objective?
What target value is needed
to meet our objective?
What are we doing to reach our
target?
Fin
an
cia
l Reduce “overhead” expenses • Proportion of budget allocated to
administrative expenses < 10%
• Switch telecom service to
less expensive provider
Expand market share • # of customers 7,000,000 • Advertising campaign in
Northern Ontario
Cu
sto
me
r Improve customer satisfaction • Customer satisfaction survey
scores 4.5 (out of 5)
• Customer service training
for all employees
Reduce customer complaints • Number of customer complaint
letters < 10/week
• Operational service
management reporting
Inte
rna
l
Pro
ces
se
s Reduce helpdesk call answer
times • # of rings before answering < 3
• Add additional customer
service representatives
Improve service activation
turnaround time
• # of days customer waits for
new service < 2
• Develop “quick response”
activation teams
Lea
rnin
g &
Gro
wth
Improve staff retention • Staff turnover rate < 5% • Develop employee health
& wellness program
Enable paperless offices • # of pages printed < 10,000 / month • Deploy laptops to staff
• Prevent email printing
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Be SMART!
Specific
Measurable
Attainable
Relevant
Time Bound
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Are these SMART objectives
for a hospital?
1. Be a leader in cardiac care
2. Improve patient satisfaction
scores by 5%
3. Provide the best coffee in the
world!
4. Reduce childhood cancer rates
in Ontario by 10%
5. Work in collaboration with key
partners
6. Reduce annual operating
expenses by 2%
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Selecting Measures
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• Ultimate Goal: Measures perfectly indicate the degree of progress made
toward achieving the corresponding objective
• Reality:
– Perfect measures rarely exist!
– Therefore, practical goal is to come as close as possible
• Considerations: – Leading vs lagging measures
– Data quality, availability, cost & reporting turnaround time
– Accountabilities
– Proxies
Practice choosing measures for these objectives:
1. Be a leader in cardiac care
2. Improve patient satisfaction scores by 5%
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Setting Targets
• SMART objectives suggest what the target should be
• Consider “stretch” targets that are demanding but attainable
• Targets can be set based on:
– Your own historical performance
– Peer performance
– Recognized standards or benchmark
• Think how a patient would set your targets
• To improve buy-in, discuss targets with your staff rather than
simply announcing them
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Learning Objectives: Module 1
Can you answer:
• What problem are Balanced Scorecards trying to solve?
• What are the benefits of using Balanced Scorecards?
• What do SMART objectives look like?
• What should you consider when selecting measures?
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End of Theory Burst #1
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20
Group Exercise: Module 1
• Glance over the case study, 10 minutes
• Divide into groups and design a scorecard by filling in
the worksheet, 20 minutes
• Within your group, discuss the questions, 15 minutes
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Group Discussion
1) Given the objectives and measures you’ve chosen,
now describe the strategy you’re trying to achieve
2) What story can you tell about how the objectives and
measures work together to achieve your strategy?
3) Reflect on the four perspectives of the balanced
scorecard. Which one perspective will be most
important:
– Over the next one year?
– Over the next five years?
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Balanced Scorecard Workshop Theory Burst #2: Balanced Scorecards in Healthcare
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Learning Objectives: Module 2
At the end of the module, participants will be able to
answer:
• How are Balanced Scorecards used today?
• What are strategy maps and why are they used?
• How are Balanced Scorecards used in healthcare settings?
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BSCs Today
• Traditional BSCs work well as performance
measurement tools for for-profit businesses but not all
organizations are focused on maximizing profit
• Organizations have different goals and different
strategies for achieving their goals
• BSCs can be adapted and linked to an organization’s
strategy to create a strategic management system
• Linking BSC to strategy is done through a strategy
map
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Strategy Map
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• Visually communicates management’s thinking behind
the organization’s strategy
• Demonstrates how an organization creates value
• Makes it easier for all staff to see their role in strategy
• Focuses on the few things that make the biggest
difference
– Warning: Do not try to capture everything you do!
• Can be applied equally well to individual
programs/units or to the organization as a whole
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Strategy Map
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How to create a Strategy
Map:
1. Clearly identify strategic
objectives
– Generally represented as an
oval or square
2. Group objectives by
perspective
3. Draw lines between objectives
to show the cause and effect
relationships
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Example #1: Product Company
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*Ref: Rapid Business Intelligence Success website (www.rapid-business-intelligence-success.com/strategy-map.html), Feb 10, 2014.
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Example #2: Utility Company
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*Ref: Balanced Scorecard Institute website (balancedscorecard.org), Feb 10, 2014.
Notice that
“Customer” and
“Financial”
perspectives
have been
flipped → that’s
OK!
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Example #3: SickKids
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*Ref: Hospital for Sick Children (SickKids) website (www.sickkids.ca), Feb 10, 2014.
Can you
recognize the
scorecard
“perspectives”?
Do the cause &
effect linkages
make sense?
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Example #4: Strategy Map & Scorecard
Strategy Map Objective Measure(s) Target
Sta
ke
ho
lde
r Im
pa
cts
Public participation in what we
do • # of public/patients involved in our initiatives
Increasing
Trend
Drive evidence-based quality • % strategic partners adopting our quality
improvement products 80%
Contribute to system
sustainability • % of funding recommendations adopted by MOH 95%
Public-focused health care
reporting • # of unique downloads of our reports 5000
Bu
sin
es
s P
roc
es
se
s
Effective communications • % media uptake for our announcements
• # of social media followers
75%
300
Healthy partnerships &
relationships
• % partners that score ≥ 80% on pulse check
• % partners that report we appear coordinated TBD
Internal alignment &
integration • % staff participation in int. integration activities 80%
Excellence in planning &
delivery
• % of corporate milestones delivered on-time
• % budget spent according to plan
100%
100%
Org
an
iza
tio
na
l C
ap
acit
y
World class web products • # of unique users visiting our web site 5000
Improved staff retention • Staff turnover rate
• Average time to hire
< 5%
6 wks
Improved staff engagement
• Staff satisfaction
• Staff involvement
• Staff commitment
+20%
+30%
+10%
Improved budget performance • Budget variance
• # of months of cash available for operations
± 2%
2 months
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Public-
focused
health care
report
Drive
evidence-
based quality
Public &
system
confidence in
what we do
Improve
system
sustainability
Development
of evidence-
based rec’s
Substantial
adoption of
our products
Healthy
partnerships
Internal
Alignment &
Integration
World class
web products
& technology Improved
Staff
Retention
Fostering a
Learning
Culture Improved
Budget
Performance
Improved
Staff
Engagement
Access to
high quality
data &
information
Excellence in
planning &
delivery
Effective
comms
System-
focused
capacity
building
Pulling It All Together
Strategy Map Balanced Scorecard Action Plan
Perspective Objective(s) Measure(s) Target(s) Initiative(s) Deadline Owner
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Low-level enablers,
resources & assets
High-level outcomes
& objectives
Internal processes,
& capabilities
Guidance for choosing
perspectives
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Learning from Experience
• Starting with a clear strategy is essential
• Limit the number of objectives & measures to a focused few
(ideally 2-3 per perspective)
– Avoid indicator chaos
– Start simple and be SMART
• Focus on the few things that make the biggest difference
– Warning: Do not try to capture everything you do!
• Management discussions about the strategy map are as
valuable as the final result and scorecard
– Never try to short-cut this process; it is how ownership is
developed
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33
Learning Objectives: Module 2
Can you answer:
• How are Balanced Scorecards used today?
• What are strategy maps and why are they used?
• How are Balanced Scorecards used in healthcare settings?
www.HQOntario.ca
End of Theory Burst #2
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35
Group Exercise: Module 2
• In the previous exercise, we looked at how other
organizations use the BSC for strategy in general
• In this exercise, we’ll look at how you can use the BSC
for quality in particular
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Attributes of High-Quality Health System
Accessible
Patient-Centred
Appropriately Resourced
Effective
Equitable
Integrated
Safe
Efficient
Focused on Population
Health
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37
Group Exercise: Module 2
• Divide into small groups (2-3 people) and design a
quality scorecard by filling in the worksheet, 20 mins
• Within your group, discuss the questions, 10 mins
• Discuss common themes across the groups, 30 mins
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Group Discussion
1) Given the objectives and measures you’ve chosen,
now describe the strategy you’re trying to achieve
2) What story can you tell about how the objectives and
measures work together to achieve your strategy?
3) Reflect on the four perspectives of the balanced
scorecard. Which one perspective will be most
important:
– Over the next one year?
– Over the next five years?
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www.HQOntario.ca
Balanced Scorecard Workshop Wrap-Up
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Strategy to Action
Mission
“Why we exist”
Values
“What we believe in”
Vision
“What we want to be”
Strategy
“Our game plan”
Strategy Map
“Translate the Strategy”
Balanced Scorecard
“Measure and Focus”
Targets & Initiatives
“What we need to do”
Personal Objectives
“What I need to do”
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*Ref: Adapted from “Quality in the Community” presentation, Donna Cripps, May 10, 2013.
Pulling It All Together
Strategy Map Balanced Scorecard Action Plan
Perspective Objective(s) Measure(s) Target(s) Initiative(s) Deadline Owner
www.HQOntario.ca
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Health Quality Ontario: http://www.hqontario.ca/
Quality Improvement Plans (QIPs): ◦ Webinar Series - http://www.hqontario.ca/quality-
improvement/quality-improvement-planning/webinars
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