During each stage of an organization's improvement journey, the discussion changes and therefore their Balanced Scorecard content/structure changes.
- Before improvement you look for root cause.
- During improvement you verify that suggested remedies fix the problem.
- After improvement you sustain the gains you've achieved.
Take for example a hospital with poor performance in the medication reconciliation component of their patient safety composite. That would appear on your top level scorecard as the lagging measure "Accurately and Completely Reconcile Medications Across Continuum of Care" which is the Joint Commission's National Patient Safety Goal 8A.
Scorecard Structure Prior to Improvement: the first action will be to charter a project team to look into root causes and suggested remedies. The scorecard should show three things at this point:
- The Lagging Measure: "Percent of Medications Accurately and Completely Reconciled Across Continuum of Care."
- The Dimensional Drill Down Measures: Break down the lagging measure by the same unit of measure across your departments to see if the problem is systemic or exists in just a few areas.
- The New Initiative: You want to get a status on the timing, budget, and resources right away and make sure your team gets to root causes as quickly as possible. They might follow the PDCA, Test of Change, CAP, RPI, or even Lean Six Sigma project methodology to do so.
Scorecard Structure During Improvement: at this point the project team has some ideas about root causes, but you need to verify that their suggested remedies both improve performance on the root causes and ultimately improve performance on the lagging measure. The scorecard will therefore show:
- The Lagging Measure: you want to see if improvement in the root cause measure has a positive influence on performance in the lagging measure.
- The Dimensional Drill Down Measures: you may choose to make improvements in selected departments first, so improvement may appear here first.
- Root Cause Measure(s): You need to set a performance target on the root cause measure to see if the remedies put in place make an impact. An example might be the "Number of Medication Transcription Errors."
- The New Initiative: You still want to keep track on the timing, budget, and resources of this project now that they are working on training and process changes.
Scorecard Structure After Improvement: at this point the project team is focusing on rolling out the new tools and processes via training and observation. You should expect to see:
- The Lagging Measure: you want to see if improvement is sustained in the measure you care most about.
- The Dimensional Drill Down Measures: you want to see that all departments are sustaining improvement.
- New Root Cause Measure(s): At this point, training and adoption of new procedures and tools is so vital that you need to place measures on your scorecard that monitor this. Examples might be: % of physicians trained on new procedures, % of new tools used properly.
Comments