applying balanced score card

Applying Balanced Scorecard

A Zulekha Hospital Case study

Dr Kishan Pakkal

Director -Operations

&

Gururaj Rai ,MHA

Business Development Manager

Presented in Thailand 2006 –Healthcare Conference

Today’s Presentation

• Zulekha Healthcare Group Overview

• Beginnings, evolution of BSC process

• A new era of accountability

• To Judge the results

Zulekha Healthcare Group

OverviewHospitals

• Zulekha Hospital – Sharjah – 60 beds

• Zulekha Hospital – Dubai - 75 beds

Medical Centres• Zulekha Medical Centre - Qusais, Dubai• Zulekha Medical Centre - Al Wahda, Sharjah• Zulekha Medical Centre - Dhaid, Sharjah

Pharmacies• Pharmacy - Al Rafea, Qusais, Dubai• Pharmacy - Zulekha Hospital, Sharjah• Pharmacy - Zulekha Hospital, Dubai

Overview of Zulekha Hospital’s

care program

• Popular Healthcare units at Dubai and

Sharjah

• Notable specialty departments – Gynaec

and Laparoscopy, Invasive Cardiology,

Orthopedics and Knee replacement

• ISO Certification and currently in line with

JCI accreditation.

Strategic Planning so far

• As an healthcare provider we are striving

for Quality Care through International

accreditations

Resulted In….

• A very comprehensive plan being

developed

• Too many Indicators, Contained no real

accountability

• Anyone who had an idea got their item in

the plan

• Indicators linked to performance and not to

strategy

Other factors

• Changes in the external Healthcare

environment, such as the Healthcare

Quality drive by Health Authority

Initial Progress

• Progress

Began tracking Hospital performance on various deployed quality indicators.

• Pitfalls

Functioned primarily as a kind of isolated meter, with no connectivity of the measures.

Rather than a new way of running the Hospital, It was one more thing to do every month

The Problem..

• We were trying to work with a performance

measurement tool in advance of crafting a

focused business strategy.

A New Approach Taken

• Decision was made to take a different approach to strategy development.

• We viewed ourselves as a business and identified our margin, market opportunities, which shaped the financial dimension of our strategy map.

• This increased margin opportunity would then allow us to reinvest in the non-growth areas of the organisation

• Pilot study has been deployed by

implementing Balanced Score Card on

Radiology Department to study its efficacy

Balanced Score Card

Balanced score card

• Balanced Scorecard is simply a concise report

featuring a set of measures that relate to the

performance of an organization.

• BSC gives management a framework or

language which would communicate the

organisation's mission and strategy, while using

measurement to inspire employees to achieve

specified outcomes.

• Imagine flying a Boeing just with one

meter – it would be disastrous.

• BSC advocates the same philosophy, that

Organization should be looked beyond

Financial meter.

• It focuses not only on financial areas that

were of significant importance traditionally

but also on Internal process, customer and

learning and growth

The Balanced Score Card Mantra

• Organizatons should clearly communicate

their vision and strategy to all levels of the

management and look at critical success

measures to achieve the goal.

• Real success just not depends on

achieving financial goals.

• How did we apply Balanced score Card ??

First, understanding our Customers

Value propositions to provide clarity in

strategy

BASIC CARE

PATIENTS

SPECIALITY CARE

PATIENTSINSURANCE CO.

CORPORATES

CUSTOMER

INTIMACY

BRAND &

TECHNOLOGY

LEADERSHIP

OPERATIONAL

EXCELLENCE

Hospital viewed as a business unit

Balanced Score Card Approach

To financially sustain our Mission, on what must we focus ?

To achieve our Vision, how should we appear to our customers?

To satisfy our customers at which operational processes must we excel ?

How will we sustain our ability to change and improve ?

FINANCIAL

CUSTOMER

INTERNAL

LEARNING & GROWTH

Vision: To be the most efficient, competent and courteous providers of

comprehensive healthcare in the world.”

Mission : “To provide easy accessibility to high quality healthcare”

Strategy Map - Objectives

FINANCIAL

To financially sustain our Mission, on what must we focus ?

CUSTOMER

To achieve our Vision, how should we appear to our customers?

INTERNAL

To satisfy our customers at which operational processes must we excel ?

LEARNING & GROWTH

How will we sustain our ability to change and improve ?

Market opportunities Deliver Cost Efficient Care

Basic Care Patients Specialty Care Patients Referring Physicians Insurance Co.

Provide Outstanding Customer Service Clinical Excellence Strive for Operational Excellence

Instill a climate for change Implement Technology Skill and Competency Development

Build a strong Financial Base to implement the GROWTH strategy of the Hospital

Strategy Map - Measures

FINANCIAL


Market Opportunities

CUSTOMER

Excellent service and

Personal relationships

Leading technology

Leading edge expertise

Low cost service and

Innovative Programs

Easy Access On Time Service Research & Clinical practice mgmt Maximize Staff efficiency

INTERNAL

Involvement & commitment to the

missionImplement technology to

support internal processDevelop critical staffing resource plans

Develop a Quality Mindset

LEARNING & GROWTH

Corporate level Strategy MapVision: To be the most efficient, competent and courteous

providers of comprehensive healthcare in the world.”

FINANCIAL

CUSTOMER

INTERNAL

LEARNING & GROWTH

Growth Deliver Cost Efficient Care

Basic Care Patients



Specialty Care Patients

Leading technology

Referring Physicians


Insurance Co.


Innovative Programs

Provide Outstanding

Customer Service Develop Clinical Excellence Strive for Operational Excellence

Easy Access On Time Service Research & Clinical practice mgmt Maximize Staff efficiency

Instill a climate for change Implement Technology Skill and Competency Development

Involvement & commitment to the

mission

Implement technology to

support internal process

Develop critical staffing resource plans

Develop a Quality Mindset


Market

Opportunities

Balanced Score Card Initiatives

Implement Growth ROI on growth initiatives

Market Share

Implemented growth strategies in

focused areas -

Cardiology

Orthopedics

Radiology

Operating Cost

% compliance to formulary

Supply expense

Costing on surgeries

Supply standardisation and expense

reduction

Formulary Expansion

Care delivery model

Standardized Inventory system

Basic Care patients

Specialty Care Patients

Referring Physicians

Insurance/ Corporate

Implement Quality Plans to improve

Overall Patient satisfaction

Implement Marketing plan

Objectives Measures Initiatives Targets

Fin

an

cia

lC

us

tom

er

Deliver Cost Efficient

Care



Leading technology



Innovative Programs

Provide Outstanding

Customer Service

Waiting Time

Telephone access

Clinics with open access

Feedback and satisfaction

Implemented growth strategies in

focused areas -

Cardiology

Orthopedics

Radiology

Clinical Depts. With quality

plan

Patients on approved

clinical pathways

Research in targeted

growth depts.

Supply standardisation and expense

reduction

Formulary Expansion

Care delivery model

Standardized Inventory system

Bad debt / receivable

Cost reduction

Staff competency and

efficiency

Process Innovation

Quality dept. being initiated

Cost areas being mapped

HR review and assessment

IT integration

Inte

rnal

Develop Clinical

Excellence

Strive for

Operational

Excellence



Climate for Change and

commitment

Idea review

Employee/physician

satisfaction

Staff recognition and

retention

Open door policy for ideas and

innovation

Satisfaction survey

Organisation wide program

regarding commitment & pride

Technology Deployment of technology

in key patient and

operational areas

Process review – time and

motion study

Deployment for patient

education

Implement to integrate E

Medical record program

Skill and competency

development

Staffing positions in

targeted growth areas

Performance to training

and Quality education

Implement staffing and

recruitment

Implement quality education and

accountability model

Learn

ing

&

Gro

wth



Cascading the score card methodology to

Radiology Department

Vision: To be the most efficient, competent and courteous

providers of comprehensive healthcare in the world.”

Radiology - Strategy Map

Maximise Revenue

FINANCIAL

PERSPECTIVE

Growth Opportunities Increased sales

CUSTOMER

PERSPECTIVE Offer full range of

imaging services

Provide on time

service

Customer satisfaction

and enhancement

INTERNAL

PERSPECTIVE

Technology Leadership & Operational Excellence

Quality Reporting Create state of the art

Information system -PACS

On time Reporting Reducing Equipment Break down Reducing Film Wastage

Patient Education

Operational Processes

A Motivated and Prepared Workforce

LEARNING & GROWTH

PERSPECTIVE Recruit & Retain Professional &

Technical Staff

Invest in Continuous Education

Develop Communication Plan

Staff satisfaction and feedback

A New Era of Accountability

• Departmental meetings

- Performance, Strategic directions

• All Meetings use the framework of the

strategy map and score card to

communicate priorities and report on

performance

• Monthly results reported to the whole

organization via the intranet



• Monthly Executive Leadership Strategic

Operating Review Meetings :

- Review monthly performance indicators

- Majority of the meeting spent discussing

strategic issues within the context of the

strategy Map

• Director Level bi-weekly initiative progress

meetings

How is Balanced Score Card

Helping us ?

• A complete paradigm shift for developing

& implementing strategy

• Increased executive, management and

physician/staff accountability, but now with

clearly defined targets.

• Aligning the entire organisation through a

common set of well understood objectives.

• Consistency of message

• Improve patient satisfaction

• Effective communication tool for

governance, administration, management

and employees.

Finally…

Quality is everyone’s job,

and we need to do it right .

applying balanced score card

Health & Medicine