1. Board Quality Scorecard
James Pappas, MD, MBA
The speaker does not have any relevant financial relationships with any commercial interests

2. Board Quality Scorecard Agenda
Definition and purpose
General structure
Examples

3. Definition and Purpose
As the name implies, a scorecard is used to “keep track” of something (usually many things). In the business world scorecards were traditionally used almost exclusively to track financial performance.
This practice has evolved over time:
…from its early use as one-dimensional measure of financial performance to a strategic planning and measurement system.
This transition is:
Resource intensive
Not easy

4. The Balanced Scorecard
The scorecard as a strategic planning tool introduced the ‘balanced scorecard’
Financial/ Stewardship
“Financial Performance”
Internal Business Process
“Efficiency”
Organizational Capacity
“Knowledge & Innovation”
Customer/
Stakeholder
“Satisfaction”
Vision & Strategy
Strategic Objectives
Performance Measures and Targets
Strategic initiatives
A scorecard…
Should not be one-dimensional
Should contain a ‘balance’ of things important to an organization:
E.g., customer & employee satisfaction, financial performance, and process measures
Should ‘connect’ vision and strategy with activity at the ‘front line.’

5. To summarize…
A balanced scorecard is a powerful tool to keep leaders informed and focused on organizational issues and strategies.
As such, the board should be involved in choosing metrics.
Balanced scorecards not only monitor progress, they also help with setting expectations:
Create an organizational focus for what is important.
Link leadership strategy (and accompanying tactics) with activities of front line workers.
Help to make sense out of a multitude of data.

6. Board Quality Scorecard Agenda
Definition and purpose
General structure
Examples

7. Simple Rules for Scorecards
Simple is good
Avoid complicated tables of numbers; graphs are much better.
Measure what is important
Depends on vision and strategy as well as what level of the organization the scorecard is used, e.g., Board, c-suite, departmental, or front line.
The data MUST BE accurate
Actually use the data to make improvements.
Use your own performance and/or the high standards and best practices of others as benchmarks to improve—NOT the AVERAGES of others.
Review often, for example, at EVERY Board meeting.

8. Nursing Scorecard Simple Rules Simple is good
For example, the “stop light” approach
Measure what is important
Finances
Agency Labor Use
Safety
CAUTI Incidence
Falls Requiring Intervention
Falls Requiring Intervention, Quarterly
Falls With Injury
HAPU Incidence
HAPU Prevalence
Process
Patient Education

9. This YTD as % Diff of Last YTD
Nursing Scorecard
AVOID TABLES of NUMBERS!
Dept
July Actual
Monthly Av %
Diff
% Diff from July last yr.
Year-to-date values
This YTD as % Diff of Last YTD
Actual
Plan 20 91
91.3
-0.3
-0.9
90.8
-0.6 12 54 70
-23
-10
69.3 -1
-0.4 19
124
129
-3.9
132
2.3
1.5
The stop light and graph approach allows visualization
At a glance:
Four measures of CAUTI, all in control
Two have trended in right direction this quarter
Two have had statistically significant changes

10. Nursing Scorecard Graphs, please!
“A picture is worth a thousand words”
Graphs are ‘pictures of data’
Again, AVOID complex tables of numbers—the human brain is BAD with this kind of data.

11. But we don’t have the resources…
Measure what you can
Involve the Board
Make it as visual as possible. If dashboard is manual:
Itemize what is being measured
Instead of red and green lights, can have pluses and minuses
Instead of SPC charts, can have run or line charts
Avoid complex tables of data
Use the scorecard to actually make improvements
Create a culture of continuous improvement

12. Board Quality Scorecard Agenda
Definition and purpose
General structure
Examples

13. CEO Dashboard Daily: Number of Outpatient visits and “No-Shows”
First Surgical Case Start-time
Patient Volume (# admissions)
Emergency Dept.:
Time from entrance to seeing a “Doc”
Time from Decision to Admit to leaving ED for Ward
Number of patients who leave without being seen
Overtime/Per Diem costs
Any major service issue
Any major staff Engagement issue
CEO Metrics: CEOs should look at these metrics as if they were physicians: Docs don’t simply tell their patients they don’t want to measure their BP—it has to be done.
Keeping tabs on the health of your organization has to be done as well. It may mean some discomfort up front-but when you experience the long-term gains in your organization’s health you will be glad you did!
Are there any physician or staff members upset? Once you know about it, that is the time to address it. Employee engagement affects patient safety and process improvement.
The metric for staff engagement impacts the rest of your facility

14. CEO Dashboard Quarterly Issues to monitor: Quality Metrics:
Process of care metrics
Outcome metrics
Patient Satisfaction metrics
Employee Metrics: (a minimum of quarterly employee forums)
Turnover rate
Employee engagement
Physician Metrics:
Referral patterns, number
Physician satisfaction/Engagement
Philanthropy
Board Communication (should be more frequent, but not daily)
Philanthropy may not be applicable –or seen in a different way in different cultures. Are there any donations? If not, do you know why?
Board: Communicate with key board members vigorously and often. The Hospital CEO should formally measure how well he/she communicates with his/her Board
If there is a problem, and not communicated, it will fester and one day explode.
The CEO can meet with each Board member to ascertian what they define as healthy communication. (Clarifyinng expectations and measuring them). So neither a Board member or the CEO is surprised with an issue happens.

15. The End