Performance Management & Strategy Execution Blog: The Glue

Meeting IOM’s Six Aims - The Role of Accountability and Scorecards

The Institute of Medicine’s (IOM) Six Aims for Improvement state that healthcare delivery should be Safe, Timely, Effective, Equitable, Efficient, and Patient-Centered. In addition, The American Hospital Association (AHA) has a new and permanent activity called “Hospitals in Pursuit of Excellence.” This portfolio of resources is available to help hospital leaders, clinicians, and staff accelerate the transformation of care and processes to the IOM Six Aims for Improvement (www.ahaqualitycenter.org).

As you read through the summary of the Six Aims and core principles of the AHA’s Hospitals in Pursuit of Excellence (HPOE) program, there are several themes that come through very strongly. From a leadership standpoint, the need for measurement is essential. Not only do you need to know your baselines, but you also have to know the benchmarks, establish goals -- and more importantly -- decide upon and implement the initiatives which are going to move the meter on the prioritized, leading measures. 

Three of the core principles of HPOE describe the reduction of variability, removal of process variation, and the removal of inefficiency. Managing these endeavors requires organizing a portfolio of projects and initiatives. Of course, all that may actually be the “easy” part. The biggest challenge for many organizations is building the culture that supports and accelerates a pursuit of excellence. One of my favorite lines regarding culture is that “culture eats strategy for lunch every day.” Not making individual accountability a central theme of any large scale initiative only sets you up to get your lunch eaten by that cultural challenge.

So how can you go about providing a framework to build, manage, monitor and drive successful change? One way is to use Balanced Scorecards. Scorecards and tools that facilitate and promote accountability not only can help provide strong building blocks for cultural shifts, but they can also lead to organizational accountability. My colleague, Jeff Bunting, has written about this in an earlier blog:

“Ensuring that leaders and employees are accountable for business results is not primarily a technology issue. However, both the Strategy Execution methodology and related software must be designed to help nurture and facilitate personal and organizational accountability for real change to occur.”  (The Glue: Blog, 08/25/09  Jeff Bunting).   

Scorecard software that is effective in facilitating a higher level of accountability will include initiatives (with tasks and milestones) with assigned owners. Providing a status report on predetermined dates, and having the review of the initiatives “real time” in a business setting set the stage for communicating expectations. The questions, dialogue, and action items that come from these exchanges bring true value to the organization. 

How are you organizing your efforts for the IOM Six Aims or the HPOE programs? Does your approach facilitate accountability and present an audit trail of status reports, milestones, and level of achievement? Let me know what you see as a “recommended practice” for these pursuits.

Healthcare Stimulus Funds and Scorecards

The American Recovery and Reinvestment Act of 2009 (ARRA), signed by President Obama on February 17, 2009, includes $19.2 billion in provisions for healthcare information technology (HCIT). As part of this program, there are incentives through Medicare and Medicaid for the “Meaningful Use” of Certified EHR Technology.

So just what does “meaningful use” mean for hospitals? Medicare defines it so far as “using certified EHR technology and, to the satisfaction of the Secretary of HHS, demonstrating that the certified EHR technology is connected in a manner that provides for the e-exchange of health information to improve the quality of health care, such as care coordination; and, the hospital submits information, in a manner and form specified by the Secretary, on such clinical quality measures and such other measures as selected by the Secretary.”

Assuring appropriate use of ARRA funds will be a key priority for many hospitals. To that end, utilizing a scorecard methodology and product can provide the necessary tools to track, monitor, manage, and document the meaningful use of ARRA projects and programs. The Secretary of HHS will determine the measures that will be required and these measures will need to be tracked over time and submitted as “proof” for quality of care improvement requirements for incentive payments.

An effective scorecard should provide the following capabilities for hospitals and healthcare systems:

• One centralized repository of key cost, schedule, outcome, and status measures for each project with intuitive scorecard and stoplight views -- this provides healthcare clients with unprecedented capabilities to document meaningful use of ARRA funds.
• Accountability at the project/program level -- each project has an accountable person responsible for monitoring and reporting project/program progress and status. This ensures that there is personal accountability for individual projects/programs.
• Built-in audit trail -- ongoing status reports and project/program measures are maintained so it is clear what accountable parties were reporting and what issues were raised over the life of the project/program. This helps avoid unnecessary delays and removes numerous barriers.
• Tracking of leading and lagging outcome measures -- the tools and the approach enable the definition of outcome measures for each project or program and track the outcomes over the life of the project. If outcomes are not reaching the targeted goal, corrective action can be taken early in the life of the project or program. This helps ensure that the ARRA funds deliver the outcomes expected.

Hospitals will need a strong closed-loop management process to assure that ARRA funds are tracked accurately and appropriately with the right amount of transparency. Furthermore, the accountability and review process that scorecards can provide will help to diminish the chances of unwanted project and initiative delays and helps to drive a hospital’s ability to provide the outcomes envisioned by the Federal Government.

The Healthcare Information and Management Systems Society (HIMSS) has some great resources and summaries on their website regarding the ARRA and its impact on HCIT. The first link provides an overview, while the second link has valuable FAQs.

1. http://www.himss.org/content/files/HIMSSSummaryOfARRA.pdf
2. http://www.himss.org/EconomicStimulus/docs/HIMSS_FAQs_ARRA.pdf