Date: e: Thursday, February 20, 2014 Ho Hosted ed by: : HNHB - - PowerPoint PPT Presentation

Date: e: Thursday, February 20, 2014 Ho Hosted ed by: : HNHB Community Leaders Council

 This workshop is hosted by the HNHB

Community Leaders Council

 Council is co-chaired by Brother Richard

MacPhee, Executive Director, Good Shepherd, and Melody Miles, CEO, HNHB CCAC

 We’re pleased to have Nathan Doidge and

Matthew Ramenaden from Health Quality Ontario with us today to lead us in a workshop regarding Balanced Scorecards

Beth h Beader der, Execut cutive ive Directo ctor, r, North h Hamilton n Community unity Healt lth h Cent ntre re Mary Burnett, nett, CEO, , Dementia ia Alliance nce Mary Lee e Bull, Regi gion

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l Independent endent Living ng Manage ager, r, Ontario ario March ch of Dimes Jan Narduzzi uzzi, Executi cutive ve Directo tor, r, Brain Injur ury y Servi vices ces Tim Siemens mens, Executi ecutive ve Director, tor,Tab Tabor

• r Manor

Marg Pattillo llo, Adminis istrat rator

• r, Creek Way Village

ge Brother her Richard ard MacPhe hee, Execu cutive ive Directo ctor, r, Good Sheph pherd rd Steve Sherrer, CEO, AbleLiving Services Inc.

Donna a Cripps, CEO, HNHB B LHIN Melody y Miles, CEO, HNHB B CCAC Terry ry McCart rthy hy, CEO, Hamilton n Family y Health th Team am Marce cel Castonguay

• nguay, Executi

cutive ve Directo tor, r, Centr ntre de santé té communauta unautair ire Hamilton/N n/Niag agar ara Pamela la Blackwell kwell, Executi cutive ve Directo tor, r, McNal ally ly House Lori Santel telli li, Executi cutive ve Directo tor, r, Adult t Recre reati tion

• n Thera

rapy py Centre tre (ARTC RTC) Trish h Balardo, Execu cutive ive Directo ctor, r, Seni niors rs Activati ation

• n Maintenance

tenance Program am Karen n Candy, y, Executi cutive ve Directo ctor, The Carpenter nter Hospice ce

www.HQOntario.ca

Balanced Scorecard Workshop

Nathan Doidge & Matthew Ramenaden

February 20, 2014

7

Workshop Outline

www.HQOntario.ca

Module Time

Introduction 09:00 - 09:15 Theory Burst #1: Introduction to Balanced Scorecards 09:15 - 09:30 Practice: Group Exercise 09:30 - 10:00 Practice: Group Discussion 10:00 - 10:15 Coffee break 10:15 - 10:30 Theory Burst #2: Balanced Scorecards in Healthcare 10:30 - 10:45 Practice: Group Exercise & Group Discussion 10:45 - 11:15 Practice: Peer Discussion 11:15 - 11:45 Wrap-up 11:45 - 12:00

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About Health Quality Ontario

www.HQOntario.ca

• HQO works in partnership with Ontario’s health care

system to support a better experience of care, better

• utcomes for Ontarians and better value for money.
• HQO’s legislated mandate under the Excellent Care for All

Act, 2010 is to: – monitor and report to the people of Ontario on the quality of their health care system – support continuous quality improvement, and – promote health care that is supported by the best available scientific evidence

• HQO is an arms-length agency of the Ontario government.

Visit www.hqontario.ca for more information.

www.HQOntario.ca

Balanced Scorecard Workshop

Theory Burst #1: Introduction to Balanced Scorecards (BSCs)

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Learning Objectives: Module 1

At the end of the module, participants will be able to answer:

• What problem are Balanced Scorecards trying to solve?
• What are the benefits of using Balanced Scorecards?
• What are SMART objectives?
• What are key considerations when selecting measures?

www.HQOntario.ca

11

Scenario

• It’s 1980 and you are the CEO of Smith

Corona, one of the largest typewriter manufacturers in the world

• The organization is celebrating its 94th

year in business and once again has healthy profits

• All of your performance reports look

great: revenues are up & expenses are under control

• Based on these reports, your Board

tells you to grow: Open 10 new factories in the next 5 years!

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12

Background

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Staff Attrition Unhappy Clients Supply Shortages Antiquated Technology Poorly Trained Employees Financial Health

• Historically, performance

reporting was focused on financial measures alone

• General assumption: How an
• rganization performed in the

past is how they’ll perform in the future

• Problem: Quickly changing

technology and business environments make the past a very poor predictor of the future

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A Balanced View

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Financial

• How do we

look to shareholders?

Customer

• How satisfied

are our customers?

Internal Process

• How efficient

are we?

Learning & Growth

• How can we

continue to improve?

• Balanced Scorecards (BSC)

allow companies to track financial results and simultaneously monitor progress in building capabilities needed for future growth

• BSCs produce a balance

between:

– How the organization sees itself and how others see it – Short run and long run – Internal and external – Leading and lagging

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Scorecard Illustration: Telephone Company

Objective Measure(s) Target Initiatives

What are we specifically trying to achieve in each perspective? How will be measure our progress in achieving the objective? What target value is needed to meet our objective? What are we doing to reach our target?

Financial Reduce “overhead” expenses

• Proportion of budget allocated to

administrative expenses < 10%

• Switch telecom service to

less expensive provider Expand market share

• # of customers

7,000,000

• Advertising campaign in

Northern Ontario Customer Improve customer satisfaction

• Customer satisfaction survey

scores 4.5 (out of 5)

• Customer service training

for all employees Reduce customer complaints

• Number of customer complaint

letters < 10/week

• Operational service

management reporting Internal Processes Reduce helpdesk call answer times

• # of rings before answering

< 3

• Add additional customer

service representatives Improve service activation turnaround time

• # of days customer waits for

new service < 2

• Develop “quick response”

activation teams Learning & Growth Improve staff retention

• Staff turnover rate

< 5%

• Develop employee health

& wellness program Enable paperless offices

• # of pages printed

< 10,000 / month

• Deploy laptops to staff
• Prevent email printing

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15

Be SMART!

Specific Measurable Attainable Relevant Time Bound

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Are these SMART objectives for a hospital?

• 1. Be a leader in cardiac care
• 2. Improve patient satisfaction

scores by 5%

• 3. Provide the best coffee in the

world!

• 4. Reduce childhood cancer rates

in Ontario by 10%

• 5. Work in collaboration with key

partners

• 6. Reduce annual operating

expenses by 2%

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Selecting Measures

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• Ultimate Goal: Measures perfectly indicate the degree of progress made

toward achieving the corresponding objective

• Reality:

– Perfect measures rarely exist! – Therefore, practical goal is to come as close as possible

• Considerations:

– Leading vs lagging measures – Data quality, availability, cost & reporting turnaround time – Accountabilities – Proxies Practice choosing measures for these objectives:

• 1. Be a leader in cardiac care
• 2. Improve patient satisfaction scores by 5%

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Setting Targets

• SMART objectives suggest what the target should be
• Consider “stretch” targets that are demanding but attainable
• Targets can be set based on:

– Your own historical performance – Peer performance – Recognized standards or benchmark

• Think how a patient would set your targets
• To improve buy-in, discuss targets with your staff rather than

simply announcing them

www.HQOntario.ca

18

Learning Objectives: Module 1

Can you answer:

• What problem are Balanced Scorecards trying to solve?
• What are the benefits of using Balanced Scorecards?
• What do SMART objectives look like?
• What should you consider when selecting measures?

www.HQOntario.ca

End of Theory Burst #1

www.HQOntario.ca

20

Group Exercise: Module 1

• Glance over the case study, 10 minutes
• Divide into groups and design a scorecard by filling in

the worksheet, 20 minutes

• Within your group, discuss the questions, 15 minutes

www.HQOntario.ca

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Group Discussion

1) Given the objectives and measures you’ve chosen, now describe the strategy you’re trying to achieve 2) What story can you tell about how the objectives and measures work together to achieve your strategy? 3) Reflect on the four perspectives of the balanced

• scorecard. Which one perspective will be most

important: – Over the next one year? – Over the next five years?

www.HQOntario.ca

www.HQOntario.ca

Balanced Scorecard Workshop

Theory Burst #2: Balanced Scorecards in Healthcare

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Learning Objectives: Module 2

At the end of the module, participants will be able to answer:

• How are Balanced Scorecards used today?
• What are strategy maps and why are they used?
• How are Balanced Scorecards used in healthcare settings?

www.HQOntario.ca

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BSCs Today

• Traditional BSCs work well as performance

measurement tools for for-profit businesses but not all

• rganizations are focused on maximizing profit
• Organizations have different goals and different

strategies for achieving their goals

• BSCs can be adapted and linked to an organization’s

strategy to create a strategic management system

• Linking BSC to strategy is done through a strategy

map

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Strategy Map

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• Visually communicates management’s thinking behind

the organization’s strategy

• Demonstrates how an organization creates value
• Makes it easier for all staff to see their role in strategy
• Focuses on the few things that make the biggest

difference

– Warning: Do not try to capture everything you do!

• Can be applied equally well to individual

programs/units or to the organization as a whole

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Strategy Map

www.HQOntario.ca

How to create a Strategy Map:

1. Clearly identify strategic

• bjectives

– Generally represented as an

• val or square

2. Group objectives by perspective 3. Draw lines between objectives to show the cause and effect relationships

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Example #1: Product Company

www.HQOntario.ca

*Ref: Rapid Business Intelligence Success website (www.rapid-business-intelligence-success.com/strategy-map.html), Feb 10, 2014.

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Example #2: Utility Company

www.HQOntario.ca

*Ref: Balanced Scorecard Institute website (balancedscorecard.org), Feb 10, 2014.

Notice that “Customer” and “Financial” perspectives have been flipped → that’s OK!

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Example #3: SickKids

www.HQOntario.ca

*Ref: Hospital for Sick Children (SickKids) website (www.sickkids.ca), Feb 10, 2014.

Can you recognize the scorecard “perspectives”? Do the cause & effect linkages make sense?

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Example #4: Strategy Map & Scorecard

Strategy Map Objective Measure(s) Target

Stakeholder Impacts

Public participation in what we do

• # of public/patients involved in our initiatives

Increasing Trend Drive evidence-based quality

• % strategic partners adopting our quality

improvement products 80% Contribute to system sustainability

• % of funding recommendations adopted by MOH

95% Public-focused health care reporting

• # of unique downloads of our reports

5000

Business Processes

Effective communications

• % media uptake for our announcements
• # of social media followers

75% 300 Healthy partnerships & relationships

• % partners that score ≥ 80% on pulse check
• % partners that report we appear coordinated

TBD Internal alignment & integration

• % staff participation in int. integration activities

80% Excellence in planning & delivery

• % of corporate milestones delivered on-time
• % budget spent according to plan

100% 100%

Organizational Capacity

World class web products

• # of unique users visiting our web site

5000 Improved staff retention

• Staff turnover rate
• Average time to hire

< 5% 6 wks Improved staff engagement

• Staff satisfaction
• Staff involvement
• Staff commitment

+20% +30% +10% Improved budget performance

• Budget variance
• # of months of cash available for operations

± 2% 2 months

www.HQOntario.ca

Public- focused health care report Drive evidence- based quality Public & system confidence in what we do Improve system sustainability Development

• f evidence-

based rec’s Substantial adoption of

• ur products

Healthy partnerships Internal Alignment & Integration World class web products & technology Improved Staff Retention Fostering a Learning Culture Improved Budget Performance Improved Staff Engagement Access to high quality data & information Excellence in planning & delivery Effective comms System- focused capacity building

Pulling It All Together

Strategy Map Balanced Scorecard Action Plan

Perspective Objective(s) Measure(s) Target(s) Initiative(s) Deadline Owner www.HQOntario.ca

Low-level enablers, resources & assets High-level outcomes & objectives Internal processes, & capabilities

Guidance for choosing perspectives

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Learning from Experience

• Starting with a clear strategy is essential
• Limit the number of objectives & measures to a focused few

(ideally 2-3 per perspective)

– Avoid indicator chaos – Start simple and be SMART

• Focus on the few things that make the biggest difference

– Warning: Do not try to capture everything you do!

• Management discussions about the strategy map are as

valuable as the final result and scorecard

– Never try to short-cut this process; it is how ownership is developed

www.HQOntario.ca

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Learning Objectives: Module 2

Can you answer:

• How are Balanced Scorecards used today?
• What are strategy maps and why are they used?
• How are Balanced Scorecards used in healthcare settings?

www.HQOntario.ca

End of Theory Burst #2

www.HQOntario.ca

35

Group Exercise: Module 2

• In the previous exercise, we looked at how other
• rganizations use the BSC for strategy in general
• In this exercise, we’ll look at how you can use the BSC

for quality in particular

www.HQOntario.ca

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Attributes of High-Quality Health System

Accessible Patient- Centred

Appropriately Resourced

Effective Equitable

Integrated

Safe Efficient

Focused on Population Health

www.HQOntario.ca

37

Group Exercise: Module 2

• Divide into small groups (2-3 people) and design a

quality scorecard by filling in the worksheet, 20 mins

• Within your group, discuss the questions, 10 mins
• Discuss common themes across the groups, 30 mins

www.HQOntario.ca

38

Group Discussion

1) Given the objectives and measures you’ve chosen, now describe the strategy you’re trying to achieve 2) What story can you tell about how the objectives and measures work together to achieve your strategy? 3) Reflect on the four perspectives of the balanced

• scorecard. Which one perspective will be most

important: – Over the next one year? – Over the next five years?

www.HQOntario.ca

www.HQOntario.ca

Balanced Scorecard Workshop

Wrap-Up

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Strategy to Action

Mission

“Why we exist”

Values

“What we believe in”

Vision

“What we want to be”

Strategy

“Our game plan”

Strategy Map

“Translate the Strategy”

Balanced Scorecard

“Measure and Focus”

Targets & Initiatives

“What we need to do”

Personal Objectives

“What I need to do”

www.HQOntario.ca

*Ref: Adapted from “Quality in the Community” presentation, Donna Cripps, May 10, 2013.

Pulling It All Together

Strategy Map Balanced Scorecard Action Plan

Perspective Objective(s) Measure(s) Target(s) Initiative(s) Deadline Owner www.HQOntario.ca

www.hqontario.ca

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