Performance Management & Strategy Execution Blog: The Glue

Relating the "Medical Home" to Balanced Scorecards

According to a July 21st  New York Times article called “Trying to Save by Increasing Doctors’ Fees”, the latest "new, new thing" is the Medical Home, being piloted by payers across the nation. As stated in the article:

"The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital."

Here in Pennsylvania, where I live, IBC, Aetna, and Cigna are spending upwards of $13M on these programs over the next 3 years.

The way I see it, there are striking parallels between these ideas and some of the fundamentals of well-deployed Balanced Scorecards. To explain, let me translate the Medical Home concepts into Balanced Scorecard speak. The goal of the Medical Home is to save money on “downstream” costly conditions (i.e. lagging measures) by spending money on less costly “upstream” activities (i.e. leading measures). This is exactly the type of thing you would want to see on a Balanced Scorecard for a Primary Care area of a health system.

In a deployed Balanced Scorecard framework, there should be alignment between the lagging indicators of performance (e.g., the number of patients with expensive conditions) and the leading indicators that impact that measure (e.g., t he number of preventative efforts that have been shown to improve or prevent those conditions).

Strategy Execution is a Change Process - Part II

In this series of posts, I am viewing a Strategy Execution implementation through a Change Management lens.

For those needing a review, I'm comparing the ESE concepts against Kotter's latest installment, where he outlined the eight "Stages of Change."  They include:

1. - Sense of Urgency
2. - Guiding Coalition
3. - Developing a Vision
4. - Communicating the Vision
5. - Empowering Employees
6. - Short Term Wins
7. - Consolidating Wins
8. - Anchoring in the Culture

In my last post (part 1) I wrote about Sense of Urgency. So now let's discuss the Guiding Coalition. It represents the vertically integrated people who will ensure that the project succeeds, even in the tougher times. First let's talk about 'who.'

At the top, the Coalition needs a top-echelon senior executive who thoroughly understands the journey, possesses the credibility to lead the team, and has budgetary control.  This is frequently labeled the Sponsor. Often, senior executives without the requisite power base lead coalitions to an unsuccessful ending, as their perceived power and influence prove limited and insufficient to overcome the obstacles. The Sponsor doesn't need to be that involved, but they do need to be the lead 'general' constantly clearing battlefield for the team.

Hospital Scorecards: Where Should Strategy Live? How About Balance?

At all levels of a hospital or health system, from the board of directors to the nursing units and support departments, good scorecards should be "balanced," meaning that they should include objectives that represent all of the hospital's key stakeholders (e.g., patients, physicians, employees, community, financial stewardship, etc., depending on the particular hospital's situation).

But there are different reasons for that balance.

First, let me say that there will be meetings where parts and pieces of Balanced Scorecards will be reviewed, such as budget reviews, event reviews, and quality governance meetings, but these meetings are not intended to be conversations about the holistic strategy, so these won't necessarily cover the full scope of a truly "balanced" scorecard framework, which is just fine.

Now let me examine the different reasons for balance in scorecards at all levels of the hospital.

The Board Level and CEO Scorecard – All perspectives (i.e. strategic groupings) will be present and the holistic strategy will be represented. This audience views the strategy as it cuts across all the silos of the organization. This scorecard shows how success in objectives for the workforce, internal processes, and external partnerships will translate into better patient experiences and improved quality of care, as well as improved financial performance.

A Leader's Role in Driving Performance Excellence

When I was a General Manager in a company that decided to embark on a Performance Excellence program, I remember asking myself “what will I have to change in my own approach to leadership as my company negotiates this journey toward improved performance?”

Borrowing from Joseph M. Juran, the esteemed Quality Planning, Improvement, and Control guru and a contemporary of Dr. W. Edwards Deming, there are eight roles of leaders that simply cannot be delegated.

Leaders must:

1. Serve on the governance vehicle that is established to guide the performance excellence (PE) journey. These vehicles used to be called the Quality Council, but now have names like the PE Governance Committee or the PE Implementation Team or the Strategy Execution Committee. Whatever it is called, it’s a great way to ensure active participation by the leadership in the direction, status, and decisions surrounding the PE culture change.
2. Establish the high level organizational strategic goals. Many times this is done by driving and  participating in a strategic planning process and then communicating, deploying, and translating the results of that process to the entire organization.
3. Provide the necessary training to expedite the changed behaviors. The training and coaching needed for the new performance excellence approaches may include strategic planning methodologies, goal deployment, root cause methodologies, project management, structured performance reviews,and the like.

Winning a State Baldrige Award - Six Keys That Helped One Organization Do It

Ever wonder what it takes to win a state-level Baldrige Award?

Here's a high-level overview of the key factors that helped Orange County Clerk of the Courts (OCCC) in Orlando win the Florida Governor's Sterling Award this year. The Sterling Award program is 15 years old, follows the same criteria, rules, and scoring as the National Baldrige Award, and is widely recognized as one of the best state programs.

There are six areas in which OCCC has dramatically improved in just a few years time and which, in my opinion, helped them win the Sterling Award. Those areas of strength are themes that cut across the seven Sterling categories of Leadership, Strategic Planning, Customer and Market Focus, Measurement, Analysis and Knowledge Management, Workforce Focus, Process Management, and Results.

Chief Strategy Officer Titles & Roles in Healthcare

I have lately been seeing the position of Chief Strategy Officer (CSO) become more prominent in the hospital setting, either by title or by invitation to executive leadership meetings.

In the past, there was often a business development/marketing person that reviewed business opportunities and assembled a proforma for review by the hospital’s CFO and CEO. More and more, I see that same person actively engaged with the “C-suite” and, as was discussed previously on this blog (in "Is Strategy Execution Anyone's Full Time Job in a Hospital?"), an individual is sometimes named as a chief officer over strategy development and execution.

As we all know, even with improved visibility for this role, there are still debates over who actually “owns” the strategy process. Is it accounting, finance, marketing? Is it the CEO? It really shouldn’t be a question of who or where it is owned, but one of who is involved in the strategy development and execution processes, from A to Z. Are they working together? Are they, as a team, able to achieve alignment? If there is a CSO, he or she can help drive this, but -- much like quality -- strategy must be everyone's job if it's going to be executed effectively.