Introducing a balanced scorecard management system in a university anesthesiology department

A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic

BACKGROUND

The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction.

AIM

This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations.

METHODS

This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs).

RESULTS

There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations.

CONCLUSION

This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

Proposal of a multidimensional strategic-management dashboard for use in a rehabilitation respiratory unit

Health information systems are the core support to decision-making in health organizations. Economic and clinical managements often function separately, while a governance system for quality and safety functions with quality checks and performance accountability, could improve efficiency. The aims of this study were, within a respiratory rehabilitation unit (RRU), to: develop a management-strategy dashboard based on key performance areas (KPAs), identify key performance indicators (KPIs) for each KPA which allow multidimensional assessment; estimate the expected results from the implementation of this dashboard using the balanced score card (BSC) method.In December 2017, a working group was set up at the RRU to develop the dashboard by selecting criteria for KPA and determining the KPIs with their rationale, weight, calculation method, measurements, supply system, target values, and working rules.After 3 meetings, 6 KPAs and 12 KPIs for the financial area, 3 KPAs and 15 KPIs for internal processes, 6 KPAs and 8 KPIs for innovation and growth, and 4 KPAs and 5 KPIs for the Clients' Perspective were approved. A strategic map showing the cause/effect relations between the different KPAs was drawn.A BSC-based quality measurement integrating economic and clinical management dimensions is possible also in an RRU. The proposed dashboard can improve communication, strategy, information dissemination, information communication technology management, budget negotiations, organizational quality, and accountability to stakeholders.

Balanced scorecard: application in the General Panarcadian Hospital of Tripolis, Greece

PURPOSE

The purpose of this paper is to discuss the application of the balanced scorecard (BSC) in the Greek public health sector.

DESIGN/METHODOLOGY/APPROACH

The basic balanced scorecard theory has been adopted in the characteristics and individualities of the Greek public health system. The theoretical model developed was applied in the General Panarcadian Hospital of Tripolis (GPHT) in Greece. GPHT is a representative paradigm of a big regional Greek public hospital. It has about 300 beds and many clinics and specialties (internal medicine, cardiology, general surgery, intensive care unit, artificial kidney unit, etc.). Strategic management was performed for almost three years. The BSC model was formulated in an appropriate software program. The problems (both technical and managerial) faced during a three-year period along with the results of this management approach are presented in the current paper. The paper highlights some important gaps in the Greek public health system, while proposing actions to be taken.

FINDINGS

The BSC theory can be very successful under certain conditions.

ORIGINALITY/VALUE

Special attention is given to the peculiarities of the Greek public health situation. The paper presents for the first time a real life example of applying BSC in the Greek public health sector.

Development and implementation of a balanced scorecard in an academic hospitalist group

BACKGROUND

Academic hospitalist groups (AHGs) are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care. To be successful, AHGs must develop strategies to balance their energies, resources, and performance. The balanced scorecard (BSC) is a strategic management system that enables organizations to translate their mission and vision into specific objectives and metrics across multiple domains. To date, no hospitalist group has reported on BSC implementation. We set out to develop a BSC as part of a strategic planning initiative.

METHODS

Based on a needs assessment of the University of California, San Francisco, Division of Hospital Medicine, mission and vision statements were developed. We engaged representative faculty to develop strategic objectives and determine performance metrics across 4 BSC perspectives.

RESULTS

There were 41 metrics identified, and 16 were chosen for the initial BSC. It allowed us to achieve several goals: 1) present a broad view of performance, 2) create transparency and accountability, 3) communicate goals and engage faculty, and 4) ensure we use data to guide strategic decisions. Several lessons were learned, including the need to build faculty consensus, establish metrics with reliable measureable data, and the power of the BSC to drive goals across the division.

CONCLUSIONS

We successfully developed and implemented a BSC in an AHG as part of a strategic planning initiative. The BSC has been instrumental in allowing us to achieve balanced success in multiple domains. Academic groups should consider employing the BSC as it allows for a data-driven strategic planning and assessment process.

Using the balanced scorecard to mobilize human resources in organizational transformation

Traditionally, the balanced scorecard (BSC) has been an effective tool in linking measurement to strategy. However, what is least understood is how the BSC can be used to redefine organizational relationships, re-engineer fundamental processes and transform organizational culture, for superior performance in an organization with the same people, services and technology that previously delivered dismal performance. This paper highlights the process and uses York Central Hospital in Toronto, Ontario, Canada as an illustrative example.

Reviewing the application of the balanced scorecard with implications for low-income health settings

High-income countries (HICs) are increasingly making use of the balanced scorecard (BSC) in healthcare. Evidence about BSC usage in low-income countries (LICs) is deficient. This study assessed feasibility of BSC use in LICs. Systematic review of electronic databases shows that the BSC improved patient, staff, clinical, and financial outcomes in HICs. To translate the experience of BSC use in HICs to their use in LICs, the applicability parameters of the National Committee for Quality Assurance were applied. Despite contextual challenges, pilot testing of BSC use can be undertaken in selected LICs. Committed leadership, cultural readiness, quality information systems, viable strategic plans, and optimum resources are required.

Controllinginstrumente für OP-Manager

Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractiveness, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.