have a plan, or plan to fail strategic planning using the balanced scorecard 1
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HAVE A PLAN, OR PLAN TO FAILStrategic Planning Using the Balanced Scorecard
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OBJECTIVES
Participants will learn Why a Strategic Plan is important and can help manage an
organization
Relating mission, vision, and values to the plan
Elements of a Balanced Scorecard approach to planning
Measurement of plan outcomes
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PLANNING PROCESS: AVOIDING THE SILLY CYCLE
Where are you starting from?
Where do you want to get?
What are the forces that affect that journey? Internal
External
What steps will be necessary?
What tools and resources do you need?
How do you know when you’ve arrived and whether it was worth it?
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STRATEGIC PLAN: BUSINESS APPROACH TO MISSION FOCUS
Sustaining mission requires planful resource allocation that enhances quality, mitigates risk, and promotes growth
There are always more options than there are reasonable paths
All options require time and money
Success requires focus and discipline
Often, less is more How many things can your organization focus on at once?
How do you know which most enhances your mission? Value to others? Sustainability?
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WHY A STRATEGIC PLAN?
Creates a link between assumptions and outcomes Between the steps we believe will get goals met and the achievement
we actually attain
Between leadership and management functions
Provides focus Makes sure only key performance measures are used
Informs stakeholders of your efficiency and effectiveness
Spells out the connection between the benefits derived by others (our consumers and stakeholders) and organizational structures and actions
It is strategic because it is focused on ends, even while tactics are what will get us there
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BEFORE YOU PLAN…Know thyself
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WHO ARE YOU?
Mission Evolves with organization and environmental changes, but has constant
core. Current challenge – healthcare or social service?
Vision Aspirational – describes the mission fulfilled
Values Core beliefs that cannot be ignored within the organization’s culture
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VALUE PROPOSITION AND ORGANIZATIONAL PROMISE
If you come to/contract with Acme Center you will….
Why Acme and not another provider?
Do you meet a special, otherwise unmet, need?
Have you articulated this? Is it concretely spelled out? Do
staff know it?
Measurable
Do customers experience it? Clients/patients/consumers/
persons served
Payers
Community stakeholders
Is it aligned with the healthcare environment? The “Triple Aim”?
Outcomes
Person centered
Cost effective
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MARKET POSITION
Where are you in the healthcare system in your community? Competition
Customer perceptions?
Community perception?
Staff perceptions
Payer perceptions
Is that where you want to be?
May be different for different segments of your organization
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TOOLS FOR ASSESSMENT
Literature - What do industry publications, science suggest is coming?
Trade Associations What are peers seeing & doing?
Surveys Staff across the organization
Customers
Payers
Focus Groups
External Audits
Internal data Quality data
Outcomes
Satisfaction (“Patient Experience”)
Service Volume by program and staff
Revenues by payer and program
Revenues in excess (or deficit) of expense for all programs
No-show rates
Time to first appointment
Retention
Risk Assessment
Facility inspections
Technology inventory
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ANALYZE
Before you plan interpret the data Trends?
Strengths and weaknesses?
How do you compare to national or state data on key internal and external markers?
Are you providing desired value?
Honesty can be difficult
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SELF ASSESSMENT: “SWOT OR TOWS”
• Competition that is more efficient & effective, or better known
• Loss of resources• Lack of adequate workforce
• Service gaps• New services absent from
market• Staff turnover
• Minimal market share, little customer loyalty or interest
• Disengaged staff, high turnover, low quality, low productivity
• Facilities that are in disrepair or inadequate
• Lack of needed or desirable technology
• Steady customer base that wants more and new from you
• Engaged, productive, high quality staff & high retention
• Facilities that are safe & appealing
• Technology infrastructure Strengths Weaknesses
ThreatsOpportunities
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READY TO
14LEADERSHIP: VISION OF THE FUTURE
Board Mission
What should the organization accomplish (outcomes & experience)? For whom (who is to be served) ? At what cost (to the consumers, the agency, the payers)?
Represent “owners” – stakeholders – on whose behalf the mission exists
Establish the values, guiding principles for staff to work under
Keep focus on how well organizational goals are met and whether costs are reasonable for the outcomes achieved.
Constantly review board’s own contribution to goals and objectives, to mission and vision
The Board provides direction for the Strategic Planning process
Senior Leadership Counsel to the Board
Industry specific Environmental Scan
Analysis of performance and outcomes
Communication within the organization to promote buy-in
Vision
Inspiration
A compelling reason to undertake what is planned
The results of the implementation
Evaluate and re-tool the plan as needed
“Plan-Do-Study-Act”
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MANAGEMENT: ACCOUNTABILITY
Operational expertise
Input into process
Resource evaluation Staff
Infrastructure
Technology
Communication to line staff Ensure task objectives are clear
Link all staff to the plan
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LINE STAFF: IMPLEMENTATION & FEEDBACK
Provide input by remaining engaged Survey responses
Focus Groups
Align with plan and carry out mission activities
Document data that is used to create feedback loop
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A STRATEGIC PLAN SHOULD
Focus on making mission achievable
Identify the means (steps and processes) by which mission is carried out and goals attained
Define how progress will be measured
Align resources to those means – what is needed to excel at those processes identified as critical means?
Incorporate progress and outcome benchmarks
Provide for data-driven redesign
Build communication and feedback loops at all levels within the organization and with stakeholders
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IMPACT OF EFFECTIVE PLANNING
Balanced Scorecard
Clarifying Vision & Strategy
Strategic Feedback &
Learning
Planning & Target- Setting
Communi-cating & Learning
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STRATEGY IS NOT STATIC
Strategy is a hypothetical If this … , then that …
Given these internal and external conditions and trends, if we focus on these things, our goals will be achieved
Like all hypotheses, it needs to be tested
Strategy is tied to ends (mission); tactics are means
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BALANCED SCORECARD ©
Finance
Internal Process
Learning, Developme
nt, Resources
Consumer &
Community
Organizes the elements of the plan to make it focused
Four Perspectives Mission – The consumer & community
perspective
Finance – “No money, no mission” The expectations of payers, backers,
donors, business partners
Internal Process – Clinical and business practices, protocols; the mission into action that produces outcomes
Learning, Development, Resources – What do those practices take?
Robert S. Kaplan, Harvard School of BusinessDavid Norton, Harvard School of Business
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CONSUMER AND COMMUNITY PERSPECTIVE
Mission cannot be fulfilled without delivering services, engaging the community, and building alliances that add value
Value =Product attributes + Image/Credibility + Relationship
Functionality Quality Price Accessibility
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FINANCIAL PERSPECTIVE
Supports the consumer and community perspective
In for-profit sector it is primarily focused on dividends and owner’s equity
In not-for-profit it reflects the needs for Mission support
Internal reinvestment
Stewardship of public and donor funds
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INTERNAL PROCESS PERSPECTIVE
Identifies the processes that are most critical for achieving customer and stakeholder perspectives
Three critical types of business processes:
Create service delivery
Create the Service
offering
Customer Need
Identified
Customer Need
Satisfied
Innovation Process
Build Service
Operations Process
Provide the Service
ServiceProcess
Identify the market
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LEARNING & GROWTH PERSPECTIVE
Represents investment in infrastructure needed to meet process requirements
People Competencies and capabilities of employees, ability to grow and be innovative
Motivation, empowerment, alignment of incentives
Information – processes and IS capabilities
Facilities
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PERSPECTIVES, DIMENSIONS, PILLARS…WHATEVER
The Balanced Scorecard© uses these titles, you don’t have to
What makes sense for your organization?
What facilitates communication?
Commitment? “Buy-in?”
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CURRENT HEALTHCARE STRATEGIC FOCUS:THE TRIPLE AIM
The first two pillars incorporate the goals of the Triple Aim (Institute for Healthcare Improvement)
Increasingly our strategic aims need to address individuals and populations and reduce cost
Care delivery systems (processes) need to ensure care is (Institute of Medicine, The Quality Chasm, 2000)
Accessible
Timely
Equitable
Safe
Effective
Efficient
To achieve the Triple Aim, organizations need talented workforce & significant technology infrastructure
Value
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BUILDING A SCORECARD
Our typical thinking typically focuses on what we have to, on what we can do with what we have That’s not strategy; we should ask
What to we want to be?
What does that take?
How do we get there? Including giving up things that are no longer sustainable Strategy should be transparent – easy to grasp and communicate Outcomes should reflect a shared vision that can be communicated to
staff at all levels of the organization Strategic Plan processes and investments should be directed only at
what is critical to achieving the outcomes
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CONSUMER AND COMMUNITY PERSPECTIVE
If we were to fulfill our mission, our consumers and community would
Experience what?
Perceive what?
Benefit how?
Triple Aim correlates Outcomes – what is the benefit
attained for individuals? Populations? Symptoms
Functioning
General health
Patient experience Shared decision making
Satisfaction
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FINANCIAL PERSPECTIVE
If we are to support operations and growth, we need to …
Be financially sound?
Have XX% revenue in excess of expense?
Dedicate YY to growth?
Attract donors?
Triple Aim Correlate Cost of Care
Per client?
Per diagnosis?
Per episode of care?
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INTERNAL PROCESS PERSPECTIVE
If we are to achieve the consumer/community and financial goals we have established, we need
Which clinical practices?
Which business practices?
Triple Aim Correlates Processes that support
Access
Satisfaction/shared decision making
Evidence based treatment
Population Health management
Benchmarking of Outcome & Patient Experience data
Cost reduction
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LEARNING & GROWTH PERSPECTIVE
Growth
People
If we are to implement the needed practices, we need these
People Numbers?
Qualifications?
Training?
Facilities Safety?
Comfort?
Technologies Apps?
EMR?
Data & analytics?
Technology
Facilities
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Ties investment of resources and practices to desired outcomes
Facilitates communicating these relationships
Permits the testing of strategic hypotheses: If we invest in/do this, then the result will be that
• If mission is fulfilled, we would impact our community by ….• our Community, clients, advocates would experience …
Consumer & Community
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STRATEGY MAPS HYPOTHESIZED RELATIONSHIPS
Consumer/Community
Financial
Internal Process
Learning & Growth
Community needs …
Be provider of choice
Enhance outcome
s in …
Improve donation
s
Improve competitiveness
Increase revenues
Implement an EBP
Seek grantsImprove quality
Improve staff skills
Improve staff engagement
Implement computerize
d system
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MEASUREMENT – TESTING THE HYPOTHESES
Customer and Community Outcomes
State measures
Other measures of symptom improvement, functioning, general health
Patient Experience Satisfaction
Self-report measures
Focus groups
Community feedback Referral feedback surveys
Focus groups
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Finance measures - overall Margin
% Growth
Cost reduction
Days cash
Financial ratios
Unit Cost
Cost per episode
Cost per diagnosis
Finance measures – staff Service Volume (Productivity)
Concurrency
Lapsed treatment plans
Missing Prior Auths
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Internal Process Posting lag
EBP use
Waitlists
Standardization rates
Peer reviews
Time to first appointment
Time to first treatment
No-show rate
Data accessibility
Collection rates
Client complaints
Implementation time
Social media access
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Resources People
Retention rates
Turnover
Vacancy rate
Training compliance
Engagement survey data
Focus group data
Access to technology Meaningful use criteria met
Staff accessing data
Business analytics utilization
Facilities Space available
Repair and maintenance cost
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NOT ON A BOOKCASE – KEEPING THE PLAN ALIVE
Establish & communicate specific outcomes Link words (commitment to perform) into
Develop department specific objectives that make the plan actionable by line staff
Ensure reporting reflects the plan at all levels CEO to Board
Executive to CEO
Managers to executive
Line staff to managers
Translate plan into staff specific objectives
Hold people accountable to goals that have been set, communicated, and acknowledged
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MANAGING THE PLAN: IS IT ALIVE OR A DUST CATCHER? Integrate throughout
Clarity regarding organizational goals
Performance outcomes to be achieved at all
Organization
Manager
Individual
Consensus Everyone agrees goals are
understood and commit to achieving them
Authority Ability to act within area of
responsibility
Accountability Publish results
Center-wide
Program
Individual
Give feedback Reward
Coach & train
Do not compromise performance standard
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AdvancingThePlan
Get input from
the start
Pictures
Repetition
Maps
Newsletters
Retreats
Tie reports & rewards to the plan
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REPORTING
Measures within pillars Progress in deployment of
resources
Implementation of processes
Revenues and costs associated with the plan
Outcomes achieved for Individuals
Populations
Community
Structure Board, staff & Community reports to reflect progress on initiatives
