Patient Management Scorecard Checks Health of Hospital

	Bookmark This Page Email This Page Format for Printing Cite This Article Submit an Article Read More Articles
	Related Tools & Articles Merging Six Sigma and the Balanced Scorecard Aligning Six Sigma with Organizational Strategies Selection of Project Metrics
	Discussion Forum "I would like to know if there is some research on the application of Six Sigma Balanced Scorecard in a hospital." Contribute to this Discussion

B

Download Products CT Scan Throughput Project Example Process Management Training Slides DFSS Design and Implementation Scorecard

y Suresh Hemamalini and Raj Mithun

A patient management scorecard presents, in general, a comprehensive framework that helps healthcare managers to define strategies, track performance and provide information to show whether their institution is performing well in terms of its mission. By implementing this strategic management tool, hospitals can construct measures to aid performance measurements in areas essential to their strategies. Scorecards can help communicate short- and long-range goals, set performance targets, evaluate hospital responses to physician needs and track process improvement efforts.

A scorecard focuses on the patient perspective of the hospital, in other words, what patients want and how well the hospital is serving them. The scorecard can articulate what the hospital must do to satisfy its patients so as to achieve its financial objectives. To answer this question, managers must initially identify the firm's target market and clarify its patient care objectives using their critical success factors.

Mapping a Patient Care Strategy

This enables a hospital to determine the objectives and means of getting there with the use of appropriate measures to assess performance, and clarifying the linkages between drivers and strategic outcomes. It is a way for the hospital management that has well-established planning routines to better link planning to the activities, responsibilities and managerial systems of its operational units. The measures/indicators are linked with a cause-and-effect relationship. For example, reduction in service delay may increase customer satisfaction.

Strategy mapping can help in error detection by making inconsistencies and gaps in cause-and-effect linkages more visible. Periodic review of the strategy map can assist in error detection before related problems become an issue. The graphical depiction of strategy makes the entire strategy more understandable to all levels of employees and makes it much more likely to get valuable input from a variety of sources.

The measures chosen for this scorecard focus on the achievements of the hospital in reaching and satisfying its target market. The measures consist of two types – outcome measures (lagging indicator) and driver measures (leading indicator), i.e., measures which cause or drive the outcome measures. Outcome measures for this scorecard generally include measures of patient satisfaction, market share, patient retention and patient profitability and so on. These outcome measures can be sub-divided into driver measures, such as measures relating to lead times, on-time delivery, product quality and product cost.

The specific driver measures chosen depend on what the patients in the chosen target market value. If patients place on-time delivery at a premium, then the hospital's ability to achieve on-time delivery will drive outcome measures such as the level of patient satisfaction and the level of patient retention. While the outcome measures may be similar across a large number of hospitals, the driver measures will be individually tailored for each institution's product/market strategy. A traffic-light system puts the hospital's performance measures into three categories – above average (green); average (amber); below average (red).

Evaluating Health Service Performance

Today's health care organizations are more focusing to reduce the costs, improve the quality of care and meet stringent guidelines. And this has made it necessary to re-examine the method of evaluating the service performance. And that is possible using best-in-class solutions for healthcare quality using the patient management scorecard. Through this scorecard the strengths of the hospital and of the people involved can be identified. In addition to the strengths, some areas that require improvement also can be identified. So the alignment of patient care strategy with overall business strategy can be done more easily.

Managers who learn the methods of the patient management scorecard will be in a better position to lead in the future. They will have the right skills to think, plan and assess the success of their hospital.

Table 1: Template for a Patient Management Scorecard
Patient Care Objectives	Measures	Values	Targets	Color Code	Initiatives

The patient management scorecard must define the following:

• Objectives - What are the strategies to achieve quality patient care?
• Measures - How will progress for each particular objective be measured?
• Targets - What is the target value sought for each measure?
• Color Code - Color indicator with regards to measured values:
  • Above average (green)
  • Average (amber)
  • Below average (red)
• Initiatives - What will be done to facilitate the reaching of the target?

Aravind's 2005 Performance Total Outpatient Visits ….... 452,863 Paying ……………………… 234,935 Free (Direct & Camp) ..…… 217,928 Total Surgeries …………….  63,402 Paying ………………………  22,930 Free (Direct & Camp) ..……  40,472

Using a Patient Management Scorecard

Aravind Eye Care System, India's and the world's largest eye care service provider for the last 30 years, successfully implemented a patient management scorecard in its Eye Hospital in Coimbatore, India. The scorecard allowed the patient care department a better understanding of how the patients evaluated the hospital's service, thus enabling the hospital to achieve its primary goals and objectives. The important performance metrics that drive success for the hospital are measured, and can be linked to the institution's strategic objectives.

While the scorecard designed and implemented at Aravind is applicable to any other hospital, it is of particular value to that institution. Aravind is special in that its hallmarks are quality care and productivity at prices that everyone can afford. A core principle of the Aravind system is that the hospital must provide services to the rich and poor alike, yet be financially self-supporting. The mission statement for the system is: "To eradicate needless blindness by providing appropriate, compassionate and high quality eye care to all." This is achieved through high quality, large volume care and a well-organized system. With less than 1 percent of India's ophthalmic manpower, Aravind accounts for 5 percent of the ophthalmic surgeries performed nationwide.

Aravind lists its critical success factors as:

• Quality
• Speed
• Low Cost
• Familiarity
• Patient Satisfaction
• Team Spirit
• Efficient Technology

From this critical success factors, corresponding objectives and measures are designed to evaluate their performance towards patients. The success of the hospital services offered to patients is measured through the patient value proposition, efficient technology and inter-department satisfaction. Patient value proposition represents the attributes that Aravind Eye Hospital provides, through their services, to create loyalty and satisfaction for the patients. The attributes that represent the patient value proposition are organized into – quality of service, speed, low cost, image of the hospital and satisfaction level of the patients.

Figure 1: Aravind Strategy Map

Key Components of Patient Perspective

Among the key components of the patient perspective of the strategy map are:

• Patient Satisfaction: Obtaining patient feedback in a timely and useable format helps ensure that the hospital is meeting and hopefully exceeding patient expectations. It also gives insight on where changes should be made to increase satisfaction and overall success. From the strategy mapping it is understood that the reduction of service delays, affordable cost for the services and patient perception drives patient satisfaction, a lagging indicator.
• Patient Loyalty: A loyal patient develops a trusting relationship with the provider and is more interested in actively participating in a prescribed course of treatment. If a provider's service satisfies a patient, then the loyalty of that patient increases and leads to an enhanced hospital image. This indicator can be boiled down to boiled down to two questions: "Would you come back to the hospital in future?" and "Would you recommend the hospital?" This indicator is lead by patient satisfaction and patient partnership, the hospital's capacity to anticipate what patient needs even before they know they need it.
• Technical Support: The hospital must excel in IT processes to achieve patient objectives since IT is the backbone of every function in the hospital. This indicator addresses the question how well the employees are using technology to satisfy the patients and create values for them.

Examples of Scorecard Outputs

The overall objective of the patient management scorecard is to have a tool for process monitoring and performance enhancements in the patient perspective of the Aravind Eye Hospital. It was implemented not just to know how the hospital had been doing with their patients, but to knowhow well they are doing now and can expect to do in the future. IT processes were among those the hospital decided it must excel at to achieve the patient objectives. So the IT performance measures also were designed and measured along with the patient perspective indicators.

Examples are provided below in Tables 2 and 3.

Table 2: Patient Management Scorecard – Output
Critical Success Factors	Objectives	Measurements	Values	Targets June '07	Initiatives
First Choice of Eye Patients	> Improve patient satisfaction level	> Degree of out-patient satisfaction > Degree of in-patient satisfaction > Number of complaints > Number of patient surveys	79.3% 82.4% 104 1	90% 90% -30% 4/yr.	> Develop guidelines for optimal patient satisfaction > Formulate a patient complaints procedure in all the department and execute it routinely
Quality	> Greater degree of trust from patients in the service provided > Patient perception > Patient partnership	> Degree of patient loyalty > Degree of perception over the facilities provided > Degree of patients understanding discharge instructions > Number of cooperative efforts > Number of eye camps	100% 82.0% 91.4% 4 20/mo.	100% 90% 100% 8 25/mo.	> Benchmark with regard to patient loyalty > Conduct loyalty programs to the nurses and doctors > Implement TQM principles > Give training to the counselors about discharge instructions > Conduct more outreach programs
Hospital Image	> Improve the familiarity level with public	> Degree of public that know about AEH > Degree of public that prefer AEH service for eye care treatment	91.4% 65.0%	100% 80%	> Conduct more health awareness programs outside the hospital > Provide good quality service
Low Cost Service Provider	> Provide service at an affordable cost	> Degree of patients who feel that service is provided at affordable cost	72.9%	90%	> Provide quality service to all without regard to their ability to pay
Pace of Service	> Reduce the service delays > Increase the number of touch points	> Service time and waiting time of patients in ODP department > Number of patient contacts	Ns=8.3mins Nq=7.4mins Ws=26mins Wq=24mins 8	-10% -10% -10% -10% 12	> Set up patient help desks wherever needed > Cycle time optimization > Increase the service counter that holds more delay
Team Spirit	> Inter-department satisfaction	> Degree of satisfaction   – Reception   – OPD   – Specialty   – EDP   – Housekeeping   – Laboratory   – Management   – Patient counselor   – Store   – Theater	88% 82% 84% 79% 83% 85% 80% 83% 72% 83%	90%	> Execute inter-department satisfaction study between all the departments > Organize meetings for the employees to enable communication between them

Table 3: Technology Scorecard -- Output
Critical Success Factors	Objectives	Measurements	Values	Targets June '07	Initiatives
User-Friendliness	> Improve system user satisfaction level	> Degree of system user satisfaction	84%	90%	> Conduct surveys among IT users at least quarterly
Technology Excellence	> High integration of the network > High reversibility of the software	> Degree of completion > Degree of sufficiency > Degree of success > Degree of simplicity > Degree of security > Degree of swiftness	75.0% 83.0% 83.0% 57.7% 57.7% 46.2%	90%	> Provide network service between one department to the other department > Provide simulation software which solves the usual error
Response Speed	> Quickly resolve the IT complaints	> Response Time of EDP - short time - reasonable time - long time	11.5% 50.0% 38.5%	70% 30% 0%	> Response time optimization > Form a technology service team
Support	> Improve English in use of IT service (email) > Provide good help service at all times	> Percent of English coaching given > Percent of help-service provided whenever needed > Percent of self-help built into service provided	11.5% 61.5% 34.6%	100% 100% 100%	> Improve English to help nurses with emailing. > Create built-in help facility in HMS software

Conclusion: Involve All Perspectives

As a response to the changing business environment, all healthcare management would be wise implement patient management scorecards, a modern management tool to help solve problems and improve performance regarding patient services. The technology scorecard also plays a vital role and needs to be aligned with patient strategy in order to make good business decisions. Eventually the healthcare profession will fully involve the other three perspectives – financial, internal, and learning and growth – by building an all-inclusive balanced scorecard.

About the Authors: Suresh Hemamalini is a senior lecturer on the faculty at PSG Institute of Management in Coimbatore, India. She has more than eight years of industrial experience in management and administration in manufacturing and software. She has practical experience in business process re-engineering, enterprise resource planning, supply chain management and TQM. She has published a number of articles. She can be reached at hemasanjana@yahoo.com. Raj Mithun is a master's degree candidate with a marketing and systems specialization at PSG Institute of Management. His areas of interest include are enterprise resource planning, customer relations management, brand management and strategic management. He also can be reached at hemasanjana@yahoo.com.

"The Bottom Line" Links

BMG UNIVERSITY I I Lean Six Sigma Online I I • Reduce Travel Costs • Maximize Training Budget >> Get Certified Now

VILLANOVA UNIVERSITY   Earn Your Lean, Green or Black Belt Six Sigma Master Certificate Online BOOST YOUR SALARY! *$38k more than uncertified counterparts. Learn From Industry Leaders!   START NOW

SIGMAPRO MBB, Lean Sigma, & DFSS   when experience matters most...

JURAN Budget constraints halting your improvement efforts? They don't have to! Learn about our accelerated cost reduction methods.

LodeStar Institute | Public & Onsite Lean Six Sigma Also New Live WEB Training  WHY SETTLE FOR ONLINE? GET LIVE TRAINING AND PROJECT MENTORING FOR ONLINE PRICES

Finding that key person for your team is just a click away . . .     TheJobShop jobs.isixsigma.com

THE UNIVERSITY OF TEXAS AT AUSTIN 2 weeks + 1 project = Black Belt Certification

. Find us on LinkedIn Join the iSixSigma Network and Connect with Other Six Sigma Pros .

. iSixSigma Live! Summit & Awards Jan 13-16, 2009 • Miami, FL Save up to $500 • Click Here! Register by October 14 .

BEST SELLING PRODUCTS (iSixSigma Publications) Six Sigma DMAIC Training Slides The complete 2008 Lean Six Sigma DMAIC course prepares participants to perform the role of a LSS Black Belt; covering wh... Certified Lean Six Sigma Black Belt Assessment Exam Interested in assessing your knowledge of Lean Six Sigma? Preparing for certifications? Testing your students and traine... Certified Lean Six Sigma Green Belt Assessment Exam This assessment exam is useful for students interested in assessing their knowledge of Lean Six Sigma on the Green Belt ... Six Sigma Black Belt (DMAIC) Training Slides - 2009 Version! The 2009 Six Sigma Black Belt course includes over 40 more slides than the 2008 version. Contents include: 1,220 PowerPo... Process Management Training Slides The 2008 Process Management course is designed in two phases comprised of:352 Powerpoint slidesInstructor notesSlide exp... Certified Lean Six Sigma Black Belt E-book In 670 pages learn everything within the Lean Six Sigma DMAIC body of knowledge to successfully achieve Black Belt certi... 5S Training Course One of the key fundamental tools of process improvement is 5S. 5S is a methodology for organizing and minimizing item... Sell Your Products