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Measuring & Managing Health Services: The Balanced Scorecard

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Measuring & Managing Health Services: The Balanced Scorecard. David Peters, Director, Future Health Systems Research Consortium Sept 28, 2006. “What gets measured gets managed. What gets managed gets done.”. Tom Peters. Would This Measurement Describe Your Child?.

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measuring managing health services the balanced scorecard

Measuring & Managing Health Services: The Balanced Scorecard

David Peters, Director, Future Health Systems Research Consortium

Sept 28, 2006

why have a balanced scorecard
Why Have a Balanced Scorecard?
  • Health sector is complex, has many components
  • Need an efficient way to assess multiple objectives
  • Overloaded with different types of reports
  • Stakeholders demand vigilance
  • Poor measurement can lead to crisis
balanced scorecard original definition
Balanced Scorecard – Original Definition

“A multi-dimensional framework for describing, implementing and managing strategy at all levels of an enterprise by linking objectives, initiatives, and measures to an organization’s strategy.”

Kaplan & Norton, 1996

scorecard domains
Scorecard Domains

Which dimensions should we measure?

balanced scorecard general domains
Balanced Scorecard: General Domains
  • Customer Results
  • Internal Processes
  • Staff and Organizational Growth
  • Financial Results
  • Vision & Strategy
qualities of good scorecard measures
Qualities of Good Scorecard Measures
  • Valid
  • Reliable
  • Balanced
  • Easily Understood
  • Intermediable
  • Agreed Upon
  • Limited
  • Specific
  • Measurable
  • Achievable Targets
  • Relevant
  • Timely
presenting scorecards performance dashboards
Presenting Scorecards: Performance Dashboards
  • Simple to see & interpret
  • Multi-dimensional measures of critical indicators of overall performance
  • Allows for the early detection of problems and successes
  • Can be benchmarked against other data
developing the balanced scorecard
Developing the Balanced Scorecard

Frontline providers, NGOs, MOPH, donors to

agree on:

  • Purpose of BSC
  • Domains to measure
  • Unit of analysis
  • Process & frequency of review/decisions
  • Principles for benchmarking
  • Short-listing indicators based on face validity, importance, reliability
afghanistan balanced scorecard domains
Afghanistan Balanced Scorecard Domains
  • Patient & Community Results
  • Staff Results
  • Capacity for Service Provision
  • Service Provision Results
  • Financial System Results
  • Overall Vision Results
measuring perceptions

Poor

Fair

Good

Excellent

Measuring perceptions

The Naanogram

  • Many survey questions sought perceptions. But how to ask?
  • Likert scale couldn’t be understood
  • Money?
balanced scorecard improvements
Balanced Scorecard: Improvements
  • Progress has been made in most areas
  • Improvements in 22 out of 29 indicators
  • Areas of largest improvement include:
    • Shura-e-Sehie activity
    • Salary payments current
    • Laboratory functionality
    • Drug availability
    • Meeting minimum staffing guidelines
balanced scorecard problems
Balanced Scorecard: Problems
  • Improvement not consistent across all provinces or aspects of service delivery
  • Areas of concern:
    • Time spent with patients
    • Facility infrastructure
    • Sharps disposal
    • User fee guidelines
    • Patient records
successful scorecards
Successful Scorecards
  • Focus on significant, success-determining measures of organization’s total performance
  • Based on timely information
  • Predictive (leading) indicators more useful than trailing indicators