HA580 Unit 8 Transformation Performance Scorecard Example

Twelve Measures In, Forty-One Out: A Performance Scorecard for a Composite Five-Hospital System's Transformation, Drawn From Its Strategy Map, Pairing Leading and Lagging Measures and Naming One Accountable Title for Each Row

[Student Name]

Purdue University Global

HA580: Leading Health Care Transformation With Strategy Integration

Unit 8 Performance Scorecard

[Instructor Name]

[Date]

The system, measures, baselines and targets are composite and bracketed for the writer's own data; the frameworks cited are real.

The Admission Rule

A measure entered the scorecard only if it met four tests: it traces to an objective on the strategy map; its owner controls at least one of its drivers; its refresh rate matches how fast it can move; and no measure already on the card says the same thing. Forty-one proposed measures failed at least one test. The most common failure was the second: measures such as hospital-wide length of stay had no single owner who could move them.

Three Measures Left Off, and Why

Hospital-wide length of stay was left off because no single owner can move it and it does not trace to a transformation objective. Emergency department wait time was left off because it already appears on the operations report and belongs to a different plan. Physician engagement was left off because the survey runs once a year, too slowly to guide a two-year transition; it will be reviewed separately. Listing a few exclusions shows the board that the scorecard's brevity is a choice.

The Scorecard

Each row gives the measure, lead or lag, owner, the report it already appears on, frequency, baseline, target and escalation trigger. Financial

1. Total cost of care, per member each month. Lag. Vice president, population health. Insurer claims report. Monthly, [three]-month lag. Baseline [$1,140]; target [$1,105]; trigger: two months above [$1,160].

2. Shared savings earned against plan. Lag. Chief financial officer. Contract settlement. Annual, with a quarterly estimate. Baseline [none]; target [$2.4] million; trigger: quarterly estimate below [60] percent of plan.

3. Orthopedic joint venture operating margin. Lag. Vice president, surgical services. Joint venture financials. Monthly. Target [12] percent; trigger: two months below [8].

Patients

4. Admissions for conditions that good outpatient care can often prevent, per thousand members, using the federal prevention quality indicators. Lag. Chief medical officer. Quality report. Quarterly. Baseline [31]; target [27]; trigger: any quarter above [32].

5. Heart failure readmissions within [30] days. Lag. Heart failure clinic medical director. Quality report. Monthly. Baseline [19] percent; target [15].

6. Members reporting they could get care when they needed it. Lag. Chief nursing officer. Survey. Quarterly. Target [80] percent.

Internal process

7. Annual wellness visit completion among attributed members. Lead. Vice president, primary care. Clinic dashboard. Monthly. Baseline [48] percent; target [65].

8. High-risk members reached by a care manager within [30] days. Lead. Director, care management. Care management log. Weekly. Target [85] percent; trigger: two weeks below [70].

9. Same-day heart failure unit visits ending without admission. Lead. Heart failure clinic manager. Unit log. Monthly. Target [60] percent.

Learning and growth

10. Care manager caseload. Lead. Director, care management. Staffing report. Monthly. Target [60] to [75] members each; trigger: above [90].

11. Days from claim to analytics availability. Lead. Chief information officer. Data report. Monthly. Baseline [75]; target [35].

12. Share of primary care pay tied to quality and cost. Lead. Chief medical officer. Compensation plan. Annual. Baseline [15] percent; target [40].

If the board waited for total cost of care, it would learn of a problem a year late; caseloads and outreach show it within a quarter.

Leading and Lagging Pairs

Each patient and financial outcome has at least one process measure below it that moves first. Total cost of care pairs with outreach within [30] days and caseload; preventable admissions pair with wellness visits; heart failure readmissions pair with the same-day unit. The board can act on the leading measure while the lagging one is still settling.

Owners

Owners are titles, never committees, and no title holds more than [two] rows. The chief medical officer holds two; so does the director of care management. A committee cannot be asked why a measure moved.

Triggers

Triggers are thresholds that send a measure to the board's quality and finance committees before the annual review. They are set at levels that signal real change rather than ordinary month-to-month noise, judged from the measure's own history on a run chart (Provost & Murray, 2011).

Guarding Against Gaming

Measures attached to targets invite gaming: staff may make the number look better without improving care, for example by reaching high-risk members with a brief call that counts as contact (Bevan & Hood, 2006). Each process measure therefore has a definition audited quarterly, and outreach counts only if a care plan is documented.

How the Board Uses It

The full scorecard goes to the board quarterly, on two pages. Measures past their triggers come with a one-paragraph explanation from the owner. The scorecard follows the balanced scorecard idea that financial results should be read alongside the patient, process and learning measures that produce them (Kaplan & Norton, 1996).

Limits

Several baselines rest on one year of data; targets should be revisited after the first year.

References

Bevan, G., & Hood, C. (2006). What's measured is what matters: Targets and gaming in the English public health care system. Public Administration, 84(3), 517-538. https://doi.org/10.1111/j.1467-9299.2006.00600.x

Kaplan, R. S., & Norton, D. P. (1996). The balanced scorecard: Translating strategy into action. Harvard Business School Press.

Provost, L. P., & Murray, S. K. (2011). The health care data guide: Learning from data for improvement. Jossey-Bass.