BALANCED SCORECARD BALANCED SCORECARD Integrating Cost, Quality, - - PowerPoint PPT Presentation

HIMSS 2000

BALANCED SCORECARD BALANCED SCORECARD

Integrating Cost, Quality, & Satisfaction Integrating Cost, Quality, & Satisfaction Measures Measures

Steven W. Steven W. Jagiela Jagiela Douglas J. Helfrich Douglas J. Helfrich Management Engineering Management Engineering Lehigh Valley Hospital Lehigh Valley Hospital

HIMSS 2000 Annual Conference April 9-13, 2000 - Dallas, TX

HIMSS 2000

Agenda Agenda

! Lehigh Valley Hospital & Health Network ! Historical Perspective (Why Do This?) ! Approach: OI & Benchmarking ! The Project ! The Tool ! Using the Scorecard in the Budget Process ! Discussion…..Questions…..Answers?

HIMSS 2000

■ ■ How Benchmarking can help set the stage for

How Benchmarking can help set the stage for major organizational effectiveness major organizational effectiveness

■ ■ How You can build front line management

How You can build front line management muscle muscle

■ ■ How You can help your whole team row in the

How You can help your whole team row in the same direction same direction

■ ■ How to implement a simple, effective,

How to implement a simple, effective, comprehensive SCORECARD tool comprehensive SCORECARD tool

WHAT YOU WILL LEARN TODAY WHAT YOU WILL LEARN TODAY

HIMSS 2000

■ ■ Based in Allentown, Pennsylvania

Based in Allentown, Pennsylvania

■ ■ Includes:

Includes: – – Lehigh Valley Hospital (2 sites in Allentown) Lehigh Valley Hospital (2 sites in Allentown) – – Muhlenberg Muhlenberg Hospital Center - Bethlehem Hospital Center - Bethlehem – – Lehigh Valley Health Services Lehigh Valley Health Services

» » Home Health, Hospice, Sub-acute Care, Rehabilitation, Home Health, Hospice, Sub-acute Care, Rehabilitation, Pharmacy, Durable Medical Equipment, Laboratory Pharmacy, Durable Medical Equipment, Laboratory Services Services

■ ■ Over 35,000 Inpatients, 200,000 Home Care visits,

Over 35,000 Inpatients, 200,000 Home Care visits, 3,300 Births 3,300 Births

■ ■ 600+ Operating Beds & 6000+ Employees

600+ Operating Beds & 6000+ Employees

Lehigh Valley Hospital & Health Network Lehigh Valley Hospital & Health Network

HIMSS 2000

■ ■ First Level 1 Trauma Center serving 1.6 million people

First Level 1 Trauma Center serving 1.6 million people

• ver six-county area
• ver six-county area

■ ■ Regional Cancer Center

Regional Cancer Center

– – affiliated with Johns Hopkins Oncology Center affiliated with Johns Hopkins Oncology Center – – draws patients throughout northeast Pennsylvania, handling draws patients throughout northeast Pennsylvania, handling more than 1500 new cancer cases annually more than 1500 new cancer cases annually

■ ■ Member of

Member of PennCare PennCare, a provider-led, integrated , a provider-led, integrated healthcare delivery system comprised of 11 hospitals healthcare delivery system comprised of 11 hospitals in eastern Pennsylvania in eastern Pennsylvania

■ ■ Affiliated with Penn State University for residency

Affiliated with Penn State University for residency programs programs

Lehigh Valley Hospital & Health Network Lehigh Valley Hospital & Health Network

HIMSS 2000

WHY DO THIS? WHY DO THIS?

HIMSS 2000

APPROACH APPROACH

Operations Improvement & Benchmarking Operations Improvement & Benchmarking

■ ■ Comparison to “Best Practice”

Comparison to “Best Practice”

– – Operational Benchmarking Operational Benchmarking – – Clinical Benchmarking Clinical Benchmarking – – Local competitors Local competitors – – Other benchmarks Other benchmarks

■ ■ Process Improvement

Process Improvement

■ ■ Employee Suggestions

Employee Suggestions How Projects Are Initiated

HIMSS 2000

Integration of Integration of OI OI, PI, Benchmarking, and Budget , PI, Benchmarking, and Budget into Day-to-Day, Unit-level Management into Day-to-Day, Unit-level Management

Immediate Every 2 weeks Monthly Annually Capital and Operating Budgets Benchmarking Monthly Financial Reports Day-to-day

• perations

Process Improvement Operations Improvement

HIMSS 2000

THE PROJECT: THE PROJECT:

Scorecard Development and Deployment Phases Scorecard Development and Deployment Phases

Scorecard Purpose

To provide a management tool which is: Clear Consistent Timely Easily Accessible

Planning Prototype Development Deployment

HIMSS 2000

The scorecard will help us to run our

business efficiently & effectively:

• Monitor unit-level performance
• Make changes that lead to improvements
• Build budgets based on scorecard ratios

Planning Prototype Development Deployment

THE PROJECT: THE PROJECT:

Scorecard Development and Deployment Phases Scorecard Development and Deployment Phases

HIMSS 2000

Member Satisfaction

How Will We Know How We Are Doing? How Will We Know How We Are Doing?

HIMSS 2000

Member Satisfaction Quality

How Will We Know How We Are Doing? How Will We Know How We Are Doing?

HIMSS 2000

Member Satisfaction Quality

Operational Ratios:

Labor and Non-Labor

BALANCE will be key to our SUCCESS!! How Will We Know How We Are Doing? How Will We Know How We Are Doing?

HIMSS 2000

Develop Scorecard concept Build the Scorecard

Spring ‘98 Define & follow deployment process

Plan Prototype Pilot Deploy Enhance

Development Approach Development Approach

Install & refine Scorecard

Nov ‘97 Jan ‘98 Summer & Fall ‘98

HIMSS 2000

Obvious Analogy to Sports Obvious Analogy to Sports

■ ■ Highlight of

Highlight of what matters most what matters most

■ ■ Time oriented

Time oriented

■ ■ Timely reporting

Timely reporting

■ ■ Balance of measures

Balance of measures

■ ■ Comparison to Others

Comparison to Others

■ ■ Central focus (“official” record)

Central focus (“official” record)

■ ■ Influence on subsequent actions

Influence on subsequent actions

■ ■ Interest to indirect participants

Interest to indirect participants

HIMSS 2000

Current Current Yr Yr Previous Previous Yr Yr Period Period YTD YTD Period Period YTD YTD Target Target Benchmarks Benchmarks Efficiency Efficiency

■ ■

Labor Ratios Labor Ratios

■ ■

Total $ Ratios Total $ Ratios Effectiveness Effectiveness

■ ■

Quality Quality

■ ■

Satisfaction Satisfaction Economy Economy

■ ■

Revenue Revenue

■ ■

Margin Margin

SCORECARD Prototype SCORECARD Prototype

HIMSS 2000

SCORECARD PREVIEW SCORECARD PREVIEW Lehigh Lehigh Valley Hospital Valley Hospital

HIMSS 2000

Development Pre-requisites Development Pre-requisites

■ ■ Data Warehouse

Data Warehouse

– – Collection of data from source systems Collection of data from source systems

■ ■ Data Model

Data Model

– – Definition of relationships between data Definition of relationships between data

■ ■ Open Database Connectivity (ODBC)

Open Database Connectivity (ODBC)

– – Connection from PC through network Connection from PC through network

Macro-Timeline Macro-Timeline

Pilot Departments

Fall 1997

January 1998 First Team Meeting

Deployment Team Formation Prototype Development & Team Selection

Feb 1998 Pilot Launch Agreement Roles & Responsibilities Team Charter Prep for Implementation

Presentations COO Staff 1:1 Meetings

June 1998 Expansion

HIMSS 2000

Role of the Project Sponsor Role of the Project Sponsor

■ ■ Have a

Have a vision vision

■ ■ Communicate it effectively

Communicate it effectively

■ ■ Sustain the vision

Sustain the vision

– – with project team with project team – – key stakeholders and organizational leaders key stakeholders and organizational leaders

■ ■ Fly air cover

Fly air cover

■ ■ Integrate with operations to make it live!

Integrate with operations to make it live!

Scorecard Development & Deployment Scorecard Development & Deployment

Scorecard Deployment Team

Project Sponsor - COO Project Leader - Director, Management Engineering Team Members Care Management Finance Human Resources Information Systems Internal Audit Organizational Development Patient Care Services Pharmacy Management Engineering Materials Management

Plan Prototype Pilot Deploy Enhance

HIMSS 2000

Resource Managers Resource Managers

■ ■ Wage Expenses/Budget

Wage Expenses/Budget Finance Finance

■ ■ Non Labor Expenses

Non Labor Expenses Materials Mgmt Materials Mgmt

■ ■ Quality Measures

Quality Measures Care Mgmt Care Mgmt

■ ■ Customer Satisfaction

Customer Satisfaction Org Org Dev Dev

■ ■ Scorecard Mechanics

Scorecard Mechanics Mgmt Mgmt Eng Eng / IS / IS Components Team Rep

HIMSS 2000

Scorecard Development and Scorecard Development and Deployment Phases Deployment Phases

Spring 1998 LVH Pilot Departments

Pharmacy Engineering Blood Bank 6B Cardiac Cath Lab MICU/SICU Labor & Delivery Radiology Supply Distribution ED Plan Prototype Pilot Deploy Enhance

Scorecard

Kick-off Session

February 2, 1998 Scorecard

• Operational Measures
• Quality Measures
• Member Satisfaction Measures

Scorecard Deployment Phases Scorecard Deployment Phases

Departments Departments Time Frame Time Frame

■ ■ Phase I

Phase I Patient Care Patient Care Svcs Svcs July/Aug July/Aug

■ ■ Phase II

Phase II Ancillary Services Ancillary Services Sept/Oct Sept/Oct

■ ■ Phase III

Phase III Support Services Support Services Oct/Nov Oct/Nov

■ ■ Phase IV

Phase IV Administrative Administrative Svcs Svcs Nov/Dec Nov/Dec

■ ■ Non-Profiled All Other

Non-Profiled All Other Depts Depts Oct/Dec Oct/Dec All All Depts Depts Complete Complete by 12/31!!! by 12/31!!! FY’2000 Budget Preparation FY’2000 Budget Preparation Plan Prototype Pilot Deploy Enhance

HIMSS 2000

Role of Phase Manager Role of Phase Manager

■ ■ Help walk the talk

Help walk the talk

■ ■ Identify department contact

Identify department contact

■ ■ Coordinate installation with I/S

Coordinate installation with I/S

■ ■ Verify / identify unit of service

Verify / identify unit of service

■ ■ Act as SPOC

Act as SPOC

HIMSS 2000

Phase Kick-Off Phase Kick-Off

■ ■ Workshop

Workshop

– – 90-minute session 90-minute session – – Classroom setting Classroom setting

■ ■ Agenda

Agenda

– – Implementation Plan Implementation Plan – – Budget Worksheet Budget Worksheet – – Scorecard Description Scorecard Description – – Action Planning Action Planning

HIMSS 2000

P h a s e / M e a s u re s

J U L Y A U G S EP T O C T N O V D EC J A N F E B M A R

P h a s e 1 O p e ra ting R a tio s Q u a lity S a tis fa c tio n P h a s e 2 O p e ra ting R a tio s Q u a lity S a tis fa c tio n P h a s e 3 O p e ra ting R a tio s Q u a lity S a tis fa c tio n P h a s e 4 O p e ra ting R a tio s Q u a lity S a tis fa c tio n

Scorecard Expansion Plan Scorecard Expansion Plan

AUG SEPT OCT

Operating Ratios

Macro-Timeline Macro-Timeline

Pilot Departments

Fall 1997

January 1998 First Team Meeting

Deployment Team Formation Prototype Development & Team Selection

Feb 1998 Pilot Launch Agreement Roles & Responsibilities Team Charter Prep for Implementation

Presentations COO Staff 1:1 Meetings

June 1998 Expansion

HIMSS 2000

Scorecard Structure & Navigation Scorecard Structure & Navigation

Function (Profile) MGR SMC VP or ADM

Initial Deployment

HIMSS 2000

Scorecard Technology Scorecard Technology

■ ■ PC-based

PC-based

■ ■ Any Windows Environment

Any Windows Environment

■ ■ Microsoft Access

Microsoft Access

■ ■ Data Downloaded from Network Server

Data Downloaded from Network Server

HIMSS 2000

Scorecard Data Characteristics Scorecard Data Characteristics

■ ■ Does not produce

Does not produce any any data data

– – Collects data from source systems through Collects data from source systems through Data Warehouse Data Warehouse – – Brings together in single presentation Brings together in single presentation

■ ■ Translates data into information

Translates data into information

– – Re-formats and re-organizes data Re-formats and re-organizes data – – Calculates new representations of data Calculates new representations of data

■ ■ Updated in most common time dimension

Updated in most common time dimension

HIMSS 2000

SCORECARD DEMONSTRATION SCORECARD DEMONSTRATION

Initial Deployment Initial Deployment

Lehigh Lehigh Valley Hospital Valley Hospital

HIMSS 2000

Balance Is Key To Success! Balance Is Key To Success!

Quality Member Satisfaction Balanced Measures Operational Ratios

HIMSS 2000

Integration of Integration of OI OI, PI, Benchmarking and Budget , PI, Benchmarking and Budget into Day-to-Day, Unit-level Management into Day-to-Day, Unit-level Management

Immediate Every 2 weeks Monthly Annually

Capital and Operating Budgets Benchmarking Monthly Financial Reports Day-to-day

• perations

Process Improvement Operations Improvement

HIMSS 2000

Implemented Enhancements Implemented Enhancements

■ ■ Quality & Satisfaction Drill-Downs

Quality & Satisfaction Drill-Downs

■ ■ Employee Turnover & Absenteeism

Employee Turnover & Absenteeism

■ ■ Non-Payroll Labor

Non-Payroll Labor

■ ■ Labor Budgeting

Labor Budgeting

HIMSS 2000

Labor Budgeting Labor Budgeting

■ ■ Budget Forms

Budget Forms # of # of FTEs FTEs

■ ■ Labor Budget Worksheet

Labor Budget Worksheet Labor Ratios Labor Ratios

■ ■ Scorecard

Scorecard Labor Ratios Labor Ratios Method Focus

HIMSS 2000

Labor Budgeting Labor Budgeting

General Summary Staffing Pattern

Enter:

• Unit of Service
• Hours Worked per UOS Ratio
• Volume
• Days of Operation
• Personnel information

HIMSS 2000

Labor Budgeting Labor Budgeting

General Summary Staffing Pattern Enter: Hours Worked by

• shift
• day of week
• skill level

HIMSS 2000

Labor Budgeting Labor Budgeting

General Summary Staffing Pattern Provides:

• Worked FTEs
• Paid FTEs
• OT $
• Labor $
• TARGETS

HIMSS 2000

SCORECARD DEMONSTRATION SCORECARD DEMONSTRATION

Current Deployment Current Deployment

Lehigh Lehigh Valley Hospital Valley Hospital

HIMSS 2000

Current Deployment Current Deployment

■ ■ All

All Lehigh Lehigh Valley Hospital Cost Centers Valley Hospital Cost Centers

– – Over 250 cost centers & over 100 managers Over 250 cost centers & over 100 managers – – Includes non-benchmarked functions Includes non-benchmarked functions

■ ■ Access by all VPs, Administrators & COO

Access by all VPs, Administrators & COO

■ ■ Muhlenberg

Muhlenberg Hospital Center Hospital Center

– – 50 cost centers installed 50 cost centers installed

■ ■ More than 225 PCs

More than 225 PCs

HIMSS 2000

Scorecard Structure & Navigation Scorecard Structure & Navigation

Facility Function (Profile) Summary MGR SMC VP or ADM

Planned

HIMSS 2000

Planned Enhancements Planned Enhancements

■ ■ SPC on trend graphs

SPC on trend graphs

■ ■ Utilization Measures, e.g. ALOS, IP Procedures

Utilization Measures, e.g. ALOS, IP Procedures per Discharge per Discharge

■ ■ FTE & Volume Variability Graph

FTE & Volume Variability Graph

HIMSS 2000

FTE & Volume Variability Graph FTE & Volume Variability Graph

10 20 30 40 50 60 70 50 100 150 200 250 Tgt 25th 50th 75th

FTEs Volume

HIMSS 2000

do This? do This? do This? So WHY Did We So WHY Did We

HIMSS 2000

So WHY did we do this? So WHY did we do this?

■ ■ Build management infrastructure and ownership

Build management infrastructure and ownership

■ ■ Build a mechanism to allocate resources

Build a mechanism to allocate resources rationally rationally

■ ■ Raise the bar for our managers

Raise the bar for our managers

■ ■ Build agility

Build agility

HIMSS 2000

steven steven. .jagiela jagiela@ @lvh lvh.com .com douglas douglas. .helfrich helfrich@ @lvh lvh.com .com Questions? . . . . . . . . . . . . Answers! Questions? . . . . . . . . . . . . Answers!