Measure Composites on Hospital Scorecards That Work

I took some time this week to reflect on something I see on every executive level hospital Balanced Scorecard -- the dreaded "composite" measure. 

Satisfaction Composite, Safety Composite, Core Measure Composite, Engagement Composite, and on and on.  You can add a system "average" into this discussion as well. 

Composites are a reality we all live with in large healthcare organizations, but are these really meaningful measures? 

They certainly can be. They can provide visibility for the executive staff into which parts of the organization are doing well, allowing them to share best practices with teams that aren't doing so well.  Composites can also be used to set top-level targets, which help us determine if we're on track to achieve our organizational vision.

To make them helpful, there are options you should consider when you're creating composites, based upon whether you're using them to report out or using them to manage your hospital.  Let's focus on the composites that help you manage your hospital.

Question #1: Ask what you are measuring yourself against. 

This will help you pick your target (e.g., industry benchmark, top decile within the hospital, median score within the hospital); it will also help you select your choice of composites.

Question #2: Ask what behavior you are trying to promote.

My favorite composite choice: "Percent of child measures that achieved their targets"

This is a mouthful, but a very powerful composite choice.  Rather than masking the good performers and bad performers within an average, this type of composite lets you know -- at an organization level -- how many bad performers you have.  And more importantly, you know that the definition of a bad performer is the specific target you set for each child measure in your composite. 

Here's an example: Cut-On-Time Composite

This top level composite has ten child measures (one for each of the ten facilities).  If the score is 90%, that means one facility is missing target and can learn from the other nine.  This composite tells you something that you can use to manage.

Comments

[Ron Dimon]

Tim,
I would agree that so long as you can ‘drill down’ into the child components of composites (or indices), the measure can be meaningful. I would also stress that there needs to be a realistic weighting to the child measure. Not all sub-measures contribute to the composite equally. And sometimes the weighting can be multidimensional – for example ALOS (average length of stay) could have a higher weighting when patient advocacy is looking at care quality than when finance is looking at margin.
-Ron