Leading Strategic Change with Strategy Maps and Scorecards

Driving Healthcare DeliveryMay 2014

Robert S. (Bob) KaplanMarvin Bower Professor of Leadership Development, Emeritus

2

Leaders, even when sailing in smooth waters, must anticipate the dangers that lie ahead

3

“Change before you have to” Jack Welch

Executing Strategy is Leading Change

4

TQM,LeanContinuous Improvement

Fire-Fighting, Problem- Solving

Re- Engineering

Strategic Change

Incremental Punctuated / Discontinuous

Proactive:Creating

Opportunities

Reactive:Responding to a

Performance Gap

Types of Organizational Change

Source: Professor Michael Tushman, Harvard Business School

55

Identifying and communicating the need to change: The Change Agenda for the U.S. FBI after 9/11 attacks

Threat-DrivenFocusCase-Driven

Highly efficient and effective HR processesHuman CapitalInefficient and Ineffective HR processes

Qualitative Evaluation (Threat-based)

Measurement of Success

Quantitative Evaluation (Case-based)

StrategicSenior ManagementTactical

“Share; and restrict what you must”Information Sharing“Restrict; and share what you must”

Full PartnerContributor Intelligence Community

Team of ProfessionalsCultureAgents / Support

Mission-enhancing integrated IT systems; productivity tools

Information TechnologyAntiquated and disparate IT systems

Developing and applying optimal S&TScience & TechnologyApplying developed S&T

“One FBI” – integrated team approach Organization“Many FBIs” –silos

Effective, relevant and timely communicationsIneffective communications Internal

Communications

Integrated team approach OrganizationOperational silos

Past Future

Strategy drives BudgetResource ManagementBudget drives Strategy

National Security and Law EnforcementRolesLaw Enforcement

ScopeDomestic Global

FOUO/UNCLASSIFIED

6

from… …to

Departments and specialty units offer 

fragmented, disconnected health 

care 

Structure of Healthcare

DeliveryIntegrated Practice Units

Metrics of inputs and processes (e.g., 

compliance, safety, quality); no valid 

cost measurementsMeasurement Patient outcomes and costs by 

medical condition

Fee‐for‐service, capitation, global 

reimbursement Reimbursement Bundled payments for complete 

cycles of care, by medical condition

Each hospital or practice offers a full 

line of clinical services

Hospitals and physician

organizations

Integrated health care delivery 

system, including primary care in 

community‐based facilities and 

complex care offered in centralized 

tertiary facilities 

Local Geographical scope

Geographically‐integrated health 

care delivery systems

Point solutions; isolated IT systems 

for individual practices, departments, 

and facilities

Information technology

Integrated patient‐centered IT 

platform capable of tracking patient 

outcomes and information across 

multiple providers

A Change Agenda for health care executives towards Value-Based Health Care Delivery

7

A Strategic Change Agenda for a healthcare provider

Inconsistent management of revenue and expensesSteward-

ship

Customer

Processes

Learning & Growth

Effectively manages revenue and expense streams to ensure consistent reinvestment in the organization’s mission

Patient experience varies due to inconsistencies in customer service

Fragmented outreach to other hospitals and providers in the region

Some new and some outdated facilities

Patient-centric, customer-service driven organization; patients move easily through the system from registration to care to billing

Well-coordinated, integrated network of relationships with hospitals and referring providers across the region

Modern facilities, including modern inpatient facilities that promote patient privacy, comfort and healing

Pockets of excellence in the organization

Clinically-driven organization

Clinical and departmental silosFragmented culture with allegiances at department/unit level

Internally focused, reactive organization

One unified culture with strong employee pride and a commitment to our heritage and tradition

Externally focused, proactive organization

Quality and excellence at the core of everything we do

Right balance of clinical, research and education missions

Multi-disciplinary clinical centers of excellence and integrated non-clinical support functions

From… To

Future CharacteristicsPresent Characteristics

8

John Kotter on “What prevents CEOs from Leading Change?” Complacency!

• Complacency exists when people think what they are doing is right and they don't need to change. The most common cause of complacency is past success.

• In a world that is changing faster and faster all the time, complacency is cancer. Not bad. Not a problem. Cancer.

• Well-known and often still highly respected companies have the disease, and

their futures aren’t pretty. Many people, including capable CEOs, don't

recognize this in their organizations—and even more don't see it in themselves.

Success and scale usually result in an inward focus, where people don't see the

threats or opportunities that lie just outside.

9

But leadership alone is not sufficient. Businesses need management tools to implement the leader’s change agenda.

Satisfies todays customers and shareholders superbly well while also adapting to change to make the enterprise stronger in the future

A solid money maker, if it has high market share, but also bureaucratic and controlling; unable to adapt well to a changing environment

An enterprise that will soon go out of business unless it is a protected monopoly

Innovative and energetic but on the edge of chaos

Low

LEA

DER

SHIP

High

HighMANAGEMENT

Low

Source: Professor Michael Tushman, Harvard Business School

10

Inspirational Leadership and Effective Management Must Work in Harmony, Together.

Leadership creates the vision and sense of urgency. Leaders communicate, inspire and motivate.

Leadership

ManagementManagement provides the rigor, alignment, and discipline required to implement the strategy and achieve the vision.

11

The Balanced Scorecard: The Central Component in a Strategy Execution Management System

Private Sector Organizations

"If we succeed, how will we look to our

shareholders?”

"To achieve our vision, how must we look to

our customers?”

"To satisfy our customers and shareholders, at which processes must we excel?”

“How do we align our intangible assets to improve critical processes?”

“How do we have a social impact with our

citizens/constituents?”

Mission (Customer) Perspective

“To have a social impact and to attract resources and support, at which processes must we excel?”

“How do we align our intangible assets to improve

critical processes?”

“How should we manage and allocate our resources for maximum social impact?”

Financial Perspective

Customer Perspective

Process Perspective

Learning & Growth

Process

Learning & Growth

Financial

“How do we attract resources and authorization

for our mission?”

Support Perspective

Non Profit and Public Sector Organizations

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Jeollabuk-do Province, South Korea

•

Population had decreased from 2.5 mm (1966)                      to 1.87 mm (2006)

•

Last place in every index among the nation’s                                                                16 provincial governments

Gross regional domestic product

Income per capita

Financial self‐sufficiency

# of businesses and employed workers

Reliance on raw materials extraction and agriculture  © DMTHOTH via Wikimedia Commons

13

New Governor, Wanjoo Kim, Takes Office in July 2006, Re-Elected in 2010

•

Adopts Balanced Scorecard as the  Province’s performance 

management system

•

Strong opposition from labor union  and some employees

•

Challenges to develop quantifiable  performance goals

©

www.jeonbuk.go.kr/

14

Goals Achieved: 2007 to 2011• Population has begun to increase, reversing 45 years of decline

• 8.6% CAGR in GRDP; national average is 3.7%

• 1st

among 16 provinces in growth rate of exports 

Exports in 2011 = $12.8 bn

Exports in 2006 = $  5.4 bn

• Increase in percentage of GRDP from secondary (value‐added) industries  from 23% to 29%

• 350% increase in number of businesses attracted (five year average)

• Number of paying tourists increases 70%

• Fiscal self‐reliance percentage increases from 15% to 21%

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Leaders Create a Sense of Urgency by Setting a Stretch Target  and a Date by Which it Must Be Achieved

Business as Usual(Continuous Improvement)

2013 2020

WOW!BHAG

Value Gap

Stretch Stretch  TargetTarget

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• Buyer Power• Supplier Power• Barriers to Entry• Threat of

Substitutes• Industry Rivalry and

Intensity of Competition

Formulate the strategy: How we will achieve our vision while delivering on the mission and living our values.

SWOT Analysis

• Political• Economic• Social• Technological• Environment• Legal

External (PESTEL) Analysis

Industry Analysis

Strengths Opportunities

Weaknesses Threats

Strategy Formulation

• Vision• Advantage

• Scope

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Active Health used the SWOT and Balanced Scorecard frameworks to summarize its strategic analysis

Strengths Weaknesses Opportunities Threats

Financial StrengthSlowdown in managed care rate 

increasesExternal fundinng of biomedical 

researchCost pressures

Support from the Trust Declining state revenues Charitable giving to Active HealthBad debt particularly related to 

growing uninsured & underinsured population

Debt Capacity Medicaid reimbursement

Significant capital needs

Change in Govenor in 2008

Prevention & Advocacy Programs unique among providers

Decline in inpatient admissionsAdvocate changes in policies, 

programs & practices to support overall health and well‐being

Unreimbursed preventative services

Respected as an expert in childrens' health & health matters

Increase marketshare within the Midwest

Increased competition in the Midwest market

Focus on childrens' healthBranding Active Health and other 

social marketingFlat demographic

Integrated childrens' health systemDistinguishing ourselves in clinical quality, patient safety,  health 

promotionConsumer‐driven health plans

Robust electronic environment, committed to using IS in clinical care

Improve service excellence Pay‐for‐performance

Priority on patient safety & quality Address access issues Price transparency

Special programs: Kidshealth & Brightstart

Inflation on capital projects

Community & government partnerships to advance policy & practice change in prevention

Technology obsolescence

Quality healthcare professionals & delivery

competitive pay & benefits package, especially for physicians

Pediatric specialist & nursing shortages

Low vacancy rates Organizational culture Aging workforce

Below industry turnover rate Performance management Erosion of trust

Patient and family dissatisfaction as relates to access (i.e. phone, 

scheduling, website navigation)

Customer

Process Infrastructure needs

Integration of clinical treatment and community‐based prevention

Culture change initiativesLearning & Growth

Stewardship

Triple A credit rating & low cost of capital

Declining revenue sources from community organizations and 

partners

Approach 2008 elections to be able to educate candidate 

© 2012 Palladium Group, Inc.

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But a still gap exists between a leader’s vision and strategy and employees’ understanding and every day actions

“In the majority of cases—we estimate 70 percent—the real

problem isn’t bad strategy . . . It’s bad execution.”

– Fortune

MISSIONWhy we exist

VALUESWhat we believe in and how we behave

VISIONWhat we want to be

STRATEGYWhat our competitive game plan will be

“Less than 10% of strategies effectively formulated are

effectively executed.”

– Fortune

OPERATIONSHow we create and deliver value

WIIFM?

19

STRATEGY MAPDefine & communicate priorities and focus

BALANCED SCORECARDMeasure performance against priorities

MISSIONWhy we exist

VALUESWhat’s important to us

VISIONWhat we want to be

STRATEGYOur game plan

EMPOWERMENT / PERSONAL OBJECTIVESMotivate employees

INITIATIVE and PLANNING PROCESSManage actions and resources to drive change

STRATEGIC OUTCOMES

Satisfied SHAREHOLDERS

Delighted CUSTOMERS

Efficient and Effective PROCESSES

Motivated & Prepared WORKFORCE

A Strategy Map and Balanced Scorecard bridge link leadership objectives to management of initiatives, processes and employees’ everyday actions.

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#1. Financial performance, a lag indicator, measures the tangible outcomes from the strategy.

#2. The customer value proposition defines the source of value.

#3. Strategic processes create value for customers and shareholders.

Process Perspective

Financial Perspective

Customer Perspective

Sustained Shareholder

Value

Operations Management

Processes

Customer Management

Processes

Innovation Processes

Productivity Revenue Growth

Price Quality Time Function Relation Brand

Product/Service Attributes Relationship Image

Regulatory and Social Processes

Learning & Growth Perspective

Human Capital

Information Capital

Organization Capital

#4. Aligned intangible assets drive improvement in the strategic processes

A Strategy Map and Balanced Scorecard provides the foundation for a new strategy execution system.

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Skills

Growth, Achieve Scale Innovation & EducationPatient Focused Clinical & Operational Excellence

Funding/Revenue Productivity/ 

Expense Control

Culture Information/ Tools

F1‐

Finance our mission by  

investing in our people, programs 

and services

F2‐Generate revenue from the extended 

reach of an integrated delivery system and 

reimbursement optimization

F3‐Expand funding from 

grants, investments and 

philanthropy

F4 – Lower costs through clinical and 

non‐clinical process improvements

Patients & FamiliesC1‐“Give me confidence that 

I am receiving the highest 

quality of care in a safe and 

respectful environment”

Community

C3‐"Understand our 

community health care needs 

help us address them"

L1 – “Give me the 

training and skills I 

need to succeed”

L3 – Instill pride in our 

heritage and our future

L4 – “Provide me with the 

information and tools for 

today’s changing 

environment”

L2 – “Help me work 

better in teams and 

across functions”

Active Health Care Strategy MapOur mission is to improve the health of the people in the communities we serve by integrating patient care, education and research in 

a caring environment.

Core Values: Respect, Stewardship, Responsible Choices, Excellence, Community, Caring, Communications, Integrity, Scholarship

P02‐

Support the XX enterprise 

and continue to strengthen the 

brand

P03 – Achieve growth through 

business development, 

partnerships with payers and 

payment advocacy

P07‐Strenghen the academic 

medical center partnership

P08‐

Define expectations and 

engage the entire organization 

and system in innovation and 

education

Students and ResearchersC4‐

“ Provide me with an 

academic environment that 

helps me advance medical 

knowledge and improve health”

P06 –

Optimize the patient care experience 

across the continuum through coordination,  

patient  engagement, and personalized 

attention

Care Partners

C2‐"Provide me with a 

sustainable partnership for our 

patients and the health system”

We will 

enable our 

people

To deliver

the 

strategicprocesses

Ensuring 

financial 

stability to 

achieve our 

mission and 

vision

That provide 

a uniquely 

satisfying 

customer 

experience

P05 ‐

Achieve outstanding patient safety and 

quality of care relative to nationally recognized 

best practice

P04‐

Optimize core processes and service lines 

through process design and standardization, 

utilization, cost management, and evidence  

based practices

P01 – Build an Integrated Delivery System to provide coordinated services and be clinically and fiscally 

accountable for the outcomes

22

Health Reform Strategy MapPurpose Vision Values

TrustKindnessLearningService

To help people remain healthy and to provide effective, safe, high quality health care and

personal social services to the people of Ireland.

Our Vision for a reformed Health and Social Care Service for the people of Ireland is one that is trusted to:- Involve and support families and communities to achieve their full health potential- Provide timely access to affordable quality care in the appropriate setting- Deliver effective services through an integrated approach to achieve excellent health outcomes- Use resources wisely and effectively to ensure maximum benefits to the public- Foster a culture that values the people who work in the health service and that is open, transparent and accountable- Openly share and continuously improve health outcomes by learning from the experience of patients and staff

1. Positive experience for patients and public

2. Service, system & organisational changes

3. Enabling capacity & capabilities

e.g. MFTP

e.g. Hospital trusts and community organisationse.g. Integrated Models

of Care

e.g. Shared services

Organisational Perspectives Strategic Objectives .

e.g. Open Disclosure

e.g. Strategic HR

e.g. National Leadership Programme

e.g. Individual health

identifier

Real change experienced on the ground by everyone

V 1.5 SW

23

FinancialPerspective

CustomerPerspective

ProcessPerspective

Talent and Technology Perspective

A good strategy map tells the story of your strategy through cause-and-effect linkages.

F1  Grow 

financial base 

& margins F3 Increase 

productivity

F2 Grow 

targeted 

patient base

C1 Provide 

personalized 

care

C2 Provide 

easy access

L4 Understand 

& deliver on the 

strategy

L1 Hire & 

develop the 

best

L3 Provide 

technology  & 

resources

P1 Deliver a 

personal 

experience

P2 Keep 

patients 

informed

P3 Streamline 

processes

L2 Reward our 

team

What will drive margins?

• Grow services for which we can deliver excellent outcomes

How?• By providing personal care to our targeted

population• By providing easy access to our services

What should our process focus be?• Keep patients informed throughout the

process• Deliver a personal experience that focuses

on the individual and his/her needs• Streamlines inefficient clinical and

administrative processes

Will our people be prepared to do that?

• Yes, if we hire and develop people that focus on customer service

• Yes, if we reward the team for focusing on customer service and the strategy

• Yes, if we provide the team the tools they need to do their job well

Mission: To provide top‐notch healthcare to our community.

24

A good Balanced Scorecard tells the story of your strategy through a set of cause and effect measures.

F1 – Grow financial base & margins

F2 – Grow targeted patient base

F3 – Increase productivity

Strategic Objectives Strategic Measures

Customer satisfaction survey rating

# of complaints re: access

C1 – Provide personalized care

C2 – Provide easy access

Service level spot check rating

% repeat patients for separate incidents

# key processes improved vs. plan

Average # wait days to see doctor

P1- Deliver a personal experience

P2 -Keep patients informed

P3 -Streamline processes

Employee Satisfaction Survey

# employees recognized for outstanding service

% new technology used by staff

L1 – Hire & develop the best

L2 – Reward our team

L3 – Provide technology & resources

Fina

ncial

Custom

erProcess

Talent & 

Techno

logy

Total revenue

Margin (%)

% revenue from targeted patient population

% cost per FTE

25

The Balanced Scorecard connects the strategy map to objectives, measures, targets, and initiatives …

Objectives

• Keep patients informed

Statement of 

what strategy 

must achieve 

and what’s 

critical to its 

success

Target

• 2014 3.8• 2015 4.2• 2016 4.6

The level of 

performance or 

rate of 

improvement 

needed

• Customer service training

Key action 

programs 

required to 

achieve 

objectives

InitiativeMeasurement

• Service level spot check rating

How success in 

achieving the 

strategy will be 

measured and 

tracked

Strategy Map:  Diagram of the cause‐and‐effect relationships between strategic objectives

Strategic Theme: 

Revenue Growth

Financial

Learning

Customer

Internal

L4  Understand 

& deliver on 

strategy

P1 Deliver a 

personal 

experience

P2 Keep 

patients 

informed

F1 Grow 

financial base 

& marginsF2 Grow 

targeted 

patient base

C1 Provide 

personalized 

care

26

Initiatives help close the gap 

between our current and 

desired performance.

INITIATIVE

Implement automated 

order management 

system 

Time from 

order to 

shipment

12 hours

Measure

Target

Actual Target

18

12

Time (hou

rs)

gap

Measures and targets track our progress 

toward achieving and communicating the 

intent of the objective.

MEASURE / TARGET

OBJECTIVEImprove Order

Fulfillment

Objectives articulate the 

components of our strategy

Strategic Initiatives Help to Close the Performance Gap

5‐26©2010 Palladium Group, Inc. 

27

Select Strategic Initiatives that align with Strategic Objectives

1. Collect all initiatives

2. Map initiatives to strategic objectives

3. Establish rationalization criteria

4. Rationalize initiatives to meet $$$ and calendar/staff time available (based on forced ranking)

Output: Short List of Strategically Aligned Initiatives

Key Steps

Corporate Projects, Activities

Corporate Projects, Activities

Development Projects, Activities

Development Projects, Activities

Quality Projects, Activities

Quality Projects, Activities

Marketing Projects, Activities

Marketing Projects, Activities

28

Objectives Milestones

• Provide technology & resources

• % new technology used by staff

• Learning assessment project

Proc

ess

Lear

ning

Cus

tom

er

Accountable

• HR Committee

• $ xxxx

Resource Alloc.Targets InitiativesMeasuresVisionMission

• Provide personalized care

• Customer satisfaction survey rating

• ‘14 xx%• ‘15 xx%• ‘16 xx%

• Survey drafted by 6/14

• Deadline met

• Marketing Team

• $ xxxx

To p

rovi

de to

p-no

tch

heal

thca

re to

our

co

mm

unity

Be th

e co

mm

unity

hos

pita

l of c

hoic

e

Longer Term (3‐5 year) View Shorter Term (Annual and Monthly) View

Strategy

“Leadership”

Tactics

“Management”

• Service level spot check rating

• Electronic notes project

• Dept. Chairs• Complete by 2014

• All patients logged in

• $ xxxx• Keep patients informed

• ‘14 xx%• ‘15 xx%• ‘16 xx%Fi

nanc

ial

• Grow high- margin service

• % revenue from high- margin services

• ‘14 xx%• ‘15 xx%• ‘16 xx%

• Develop organization- wide survey

• ‘14 xx%• ‘15 xx%• ‘16 xx%

Strategy Map

L4  

P1 P2 

F1

F2 

C1

Strategy map and BSC links long term strategy and measures to operational planning & budgeting.

All columns to the right support columns on the left

29

Stage 3 of the Management System: Alignment

Process

Initiative

EXECUTION

3

45

6

•

Mission, Values, Vision •

Stretch Targets•

Strategic Analysis•

Strategy Formulation

DEVELOP THE STRATEGY

•

Strategy Map / Themes•

Measures / Targets•

Initiatives•

Funding / Stratex

TRANSLATE THE STRATEGY

ALIGN THE ORGANIZATION

•

Business Units•

Support Units•

Employees•

Board of Directors

PLAN OPERATIONS

•

Key process improvement•

Sales planning•

Resource capacity plan•

Budgeting

•

Profitability Analysis•

Strategy Correlations•

Emerging Strategies

TEST & ADAPT

•

Strategy Reviews•

Operating Reviews

MONITOR & LEARN

21

30

Processes

People & Learning

People & Learning

Stewardship

Customers

Processes

Active Health’s Cascading Plan

Foundation

West Region Practice Sites

East Region Practice Sites

ISHR

Lab (Ancillary Unit)

EnterpriseEnterprise

Cardio (Clinical Unit)

People & Learning

Stewardship

Customers

Processes

People & Learning

Stewardship

Customers

Processes

People & Learning

Stewardship

Customers

ProcessesPeople & Learning

Stewardship

Customers

Processes

People & Learning

Stewardship

Customers

Processes

People & Learning

Stewardship

Customers

Processes

Stewardship

Customers

Illustrative Example

© 2012 Palladium Group, Inc. - Confidential

31

Align employees to the strategy: Four HR processes

Make Strategy Everyone’s Job

1. Create Strategic Awareness

Communicate

Communicate

Communicate

2. Align Personal Goals

Personal Scorecard

3. Provide Necessary Skills

Strategic Job Families

Strategic Readiness

4. Align Personal Incentives

Variable pay

Team based

Strategy should be linked to existing HR programs for performance  management.

32

“Employees have a good understanding of the overall organizational

goals”

Well-performing organizations

Poorly-performing organizations

67% 38%

Align employees to strategy –

Communicate “seven times seven different 

ways”

Intranet

Newsletters

Posters

Town Hall Meetings

Emails

Screensavers

Large Group Meetings

Reports

Board game

Videos

Formal Speeches

Hallway/Coffeepot Conversations

Advanced Copies of Agendas

Leaders must communicate the vision and strategy using multiple media

33

A good communication plan aligns the right message, the right audiences, with the right media

Audio

Electronic

Face To 

Face

Media

Video

Print

Message

BSC Framework

Our Strategy

Progress to Strategy

Individual 

Contribution to 

Strategy

Audience

Teams And Individuals

Sites And Functions

CorporateBoard

Business UnitManagement

Telephone

Electronic/email

Face‐to‐face

Stakeholders

34

SMDC Hospital System Web-based Strategy Map

The Strategy Home Page displays the strategy map and metrics and is the starting point for the driver drill down

© 2009 Palladium Group, Inc.

35

Communication Examples

Newsletters: Strategy Map Brochures:

36

Communication Examples

Managers Tool Kit

Screen Savers

Intranet Website

Strategic Plans

Letters from Executives

37

Royal Canadian Mounted Police V Division – Iqaluit (Baffin Island)

38

Stage 4 Link Strategy to Local Operations

Process

Initiative

EXECUTION

1

3

45

6

• Mission, Values, Vision

• Strategy Formulation

DEVELOP THE STRATEGY

• Strategy Map/Themes• Measures / Targets• Initiative Portfolios• Funding / Stratex

TRANSLATE THE STRATEGY

ALIGN THE ORGANIZATION

• Business Units• Support Units• Employees

PLAN OPERATIONS

• Establish priorities for process improvement initiatives

• Risk Management

• Profitability Analysis• Strategy

Correlations• Emerging Strategies

TEST & ADAPT

• Strategy Reviews• Operating Reviews

MONITOR & LEARN

2

39

Identify operational processes key to executing strategy and manage those processes using dashboards and KPIs rather than instincts

Strategy Map

Cause-and-Effect Model of Each Key

ProcessWeb-based Dashboard

of metrics used to manage a Key Process

PROCESS linked to METRICSMETRICS improve PROCESS

Dashboards articulate the critical link between strategy management and operations management

© 2012 Palladium Group, Inc.

40

Patient accessPatient access Patient registrationPatient registration

Correct identification of patient needs (DRG) Correct identification of patient needs (DRG)

ED capacity and flow management

ED capacity and flow management

Coordination between admission points and bed management

Coordination between admission points and bed management

Speed and ease of registrationSpeed and ease of registration

Integrity of information captured during registration Integrity of information captured during registration

Nurse and physician scheduling Nurse and physician scheduling

• # of bed availability updates

Process Component Process Sub-Component Operational Driver

Scheduling speedScheduling speed

KPI

• # of patients admitted to the hospital

Knowledge of available system capacity Knowledge of available system capacity

Patient schedulingPatient scheduling

Available appointmentsAvailable appointments• # of scheduling attempts unable to make

an appointment• Unit at capacity

• Time to register patient (ED and DA)• Patient satisfaction rating with

registration

• # of registration errors• # of denials from incorrect patient

information

• Unit Meeting Notices• Daily Census

• % of time that patients wait for to be seen more than X minutes

• Wait time from the decision to admit a patient from the ED to placement of the patient in an inpatient bed

Bed availabilityBed availability

The patient access process can be “decomposed” into success factors, operational drivers, and associated KPIs

• Customer service training

• Time to make appointments (from request)• Time to 3rd available appointment

© 2012 Palladium Group, Inc

P01 - Assure service excellence & optimize

the customer experience by continuously

improving process flow and interaction

41

Dashboards for critical processes support local improvement activities by front line employees

P01 - Assure service excellence & optimize the customer experience by continuously improving process flow and interaction

4‐63

42

Stage 5 of the Management System: Monitor and Learn

Process

Initiative

EXECUTION

1

3

5

6

2

•

Key process 

improvement

•

Sales planning•

Resource capacity plan•

Budgeting

PLAN OPERATIONS4

•

Business Units•

Support Units•

Employees

ALIGN THE ORGANIZATION

• Strategy Reviews

• Operating Reviews

MONITOR & LEARN

•

Profitability Analysis•

Strategy Correlations•

Emerging Strategies

TEST & ADAPT

•

Strategy Map / Themes•

Measures / Targets•

Initiative Portfolios•

Funding / Stratex

TRANSLATE THE STRATEGY

•

Mission, Values, Vision •

Strategic Analysis•

Strategy Formulation

DEVELOP THE STRATEGY

43

The Leadership Team Conducts a Monthly Strategy Review Meeting

Performance

Initiatives

& Programsoutput

result

Strategy Review Loop

corrections

input

Strategy Review Meetings •Why did we miss the target?•What correcting actions should we consider?•Are initiatives on schedule?•Do you need more resources?•Would an multi-functional task force help?

44

Strategy MapThat supports Our Mission

Vision: Freedom from disabling conditionsMission:

To provide leadership, institutions and services to restore and improve the health of children through care and programs not readily available, with one high standards of quality and distinction regardless of the recipient’s financial status.

© 2012 Palladium Group, Inc

A color coded strategy map sets the agenda for the leadership team’s strategy review meeting

45

OBJECTIVE MEASURE INITIATIVE

P01

Assure service excellence & optimize the customer experience by continuously improving process flow and interaction

P1AP1BP1C

# of patients admitted to hospital

Average length of stay (days)

Average time of discharge (HH:MM)

New patient scheduling & planning, budgeting & forecasting system roll-out

P02Build a meaningful partnership with physicians to enhance the continuum of care

P2A % of physicians participating in task forces, leadership committees, etc.

Physician project management training initiative

P03

Communicate our brand & capabilities as an academic health center to meet the community’s healthcare needs

P3A % of facilities/departments that meet brand “standards”Brand development initiative

Welcome Center build-out

P04

Achieve exceptional outcomes through coordinated, evidence- based care, health promotion, & improved clinical processes

P4AP4BP4C

% infection rate

Clinical outcomes index rating

% of providers trained in evidence-based medicine

EMR implementation projectProvider evidence-based medicine training program

P05 Achieve outstanding patient safety and quality of care

P5AP5B

# of falls

Hand washing rateHand washing training program

P06Optimize utilization of our capital & human assets to operate efficiently

P6A Budgeted strategic initiatives that follow the planning criteria Initiative management process redesign

P07Improve efficiency and reduce cost of non-clinical processes

P7AP7BP7C

# of targeted business processes improved vs. plan

# of billing lines collected in 120 daysBilling software implementation

Scorecard Performance Summary (with selected Objectives and Measures)

= On Target= Approaching Target= Off Target= Data Not Available

© 2012 Palladium Group, Inc

46

The leadership team reviews performance, examines strategic initiatives, makea informed decisions, and assigns accountability.

Identify Performance Issues: 

Focus on the performance of objectives NOT 

measures.

What are the measures telling us?  Are the 

measures driving change and adding focus?

Analyze Objective Performance:

Take Action:

Discuss and agree on how to remedy issues.

Assign accountability to ensure decisions 

are implemented.

What are the root causes of what’s occurring? 

What are the expectations for the future? And, 

are current initiatives sufficient to close the 

performance gap?

What action steps –

including additional or 

different initiatives ‐

are required to improve 

performance going forward?

Are initiative on track to deliver expected 

value? If not, why and what can be done to 

remedy issues?    

Use of a BSC Report in 

Strategy Review Meetings1

3

5

2

4

Objective:

Discussion/Update:

Recommendations/Required Actions:

Person(s) Responsible: Due Date: Priority (A, B, C):

Action Item Detail:1.2.3.

6

7

I03 Identify Adverse Trends

47

Stage 6 of The Management System: Test and Adapt

Process

Initiative

EXECUTION

1

3

45

6

•

Mission, Values, 

Vision 

•

Strategic Analysis•

Strategy Formulation

DEVELOP THE STRATEGY

•

Strategy Map / 

Themes

•

Measures / Targets•

Initiative Portfolios•

Funding / Stratex

TRANSLATE THE STRATEGY

ALIGN THE ORGANIZATION

•

Business Units•

Support Units•

Employees

PLAN OPERATIONS

•

Key process 

improvement

•

Sales planning•

Resource capacity plan•

Budgeting

•

Profitability Analysis•

Strategy 

Correlations

•

Emerging Strategies

TEST & ADAPT

•

Strategy Reviews•

Operating Reviews

MONITOR & LEARN

2

48

Executives Adapt the Strategy at an Annual Strategy Review Meetings

Performance

Initiatives

& Programsoutput

result

Strategy Review Loop

corrections

input

Strategy Learning Loop

incorporate 

learning

update the 

strategy

• Are the data consistent 

with our strategic 

hypotheses?

• Has the environment 

changed in a fundamental 

way?

• Have new strategic options 

emerged?

Test and Adapt the Strategy

Strategy Review Questions 

•Why did we miss the target?

•

What correcting actions should we 

consider?

• Are initiatives on schedule?

• Do you need more resources?

•

Would an multi‐functional task force 

help?

49

The Kaplan-Norton six-stage closed loop management system for Strategy Execution

Process

Initiative

EXECUTION

1

3

45

6

• Mission, Values, Vision

• Strategy Formulation

DEVELOP THE STRATEGY

• Strategy Map/Themes• Measures / Targets• Initiative Portfolios• Funding / Stratex

TRANSLATE THE STRATEGY

ALIGN THE ORGANIZATION

• Business Units• Support Units• Employees

PLAN OPERATIONS

• Key process improvement

• Sales planning• Resource capacity plan• Budgeting

• Profitability Analysis• Strategy

Correlations• Emerging Strategies

TEST & ADAPT

• Strategy Reviews• Operating Reviews

MONITOR & LEARN

2