Internal Business Perspective
Duke Children’s hospital recognized the large amount of data that needed to be linked. This was done so that a true picture of the organizational performance could be accurately depicted. Secondly, key stakeholders were furnished with the relevant information so that they could make informed decisions and enhance their knowledge base. The risks associated with delivery of information were identified and taken into consideration when making the delivery so that there were no incidences of finger pointing. Using this approach, each group had to focus on their performance rather than being distracted with other departments. This ensures that each staff measures their individual efforts using the available information and makes an improvement in an intelligent manner.
The integration of the clinical and business aspects of health care at the hospital led to a significant improvement in the perspectives of the balanced scorecard. This led to a reduction in business operating costs and an improvement in the hospital’s net margin. Previously the hospital focused on a strategy of reducing costs by cutting back on staffs and services. With the adoption of the scorecard approach, the hospital is undertaking strategic investments to ensure that overall long-term success on all perspectives is realized. Employees welcomed the new approached as shown by the 29 per cent improvement in nursing units’ productivity from 1996 to 2000. In addition, the hospital reported an increase in the staff satisfaction, morbidity and the overall health of the organization.
The hospital developed the integrated score card in 1996. The scorecard created a single platform for the hospital’s quality clinical results and business outcomes. The scorecard approach was balanced as it refocused all hospital disciplines around a single strategic program. All hospital disciplines were identified based on four categories of financial, consumer, learning and development and the internal business. The hospital put focused on the increasing its productivity through the provision of the appropriate tools to increase individual worker performance. The hospital linked its mission, strategy and key performance indicators as well as initiatives by various disciplines across the organization. Secondly, the linkages forming the scorecard were aligned to its budget. Each aspect of the scorecard was assigned to a specific discipline to ensure accountability and addressed the key performance indicators (KPI), staff satisfaction and compliance with regulations (Niven, n.d.).
Aligning of the performance data was done to ensure that it give an operational picture and the perspective of the patient process in the children’s business. This was done so that operational performance of a unit is linked to the whole performance of the patient process in the hospital. There was a routine analysis of trends in volume, staff levels and cost per patient day. The patient perspective analysis that includes revenue and operating margin and volume were studied and results provided to physicians who input their views on improvement depending on the practice pattern. Once the scorecard was functional, it was leveraged with technology. Technological improvement automated the scorecard and enabled a huge chunk of data to be meaningfully used. The advancement in technology allows for faster and accurate analysis and evaluation, which moved the hospital from a crisis intervention to a strategic solution tactic. Automation ensured that all stakeholders in any discipline had access to the information at the same time wherever they were stationed (Meliones et.al. 2001).
The operating environment of the hospital present newer challenges and these are opportunities the hospital to improve on its scorecard. The business strategy change in the Duke University Children’s Hospital was a welcome reprieve for staff and patients as key stakeholders. A shift from the focus on staff cutbacks to reduce costs increased the commitment of staff to the organization. Moreover, the emphasis on individual’s performance as a contribution to the overall operational performance significantly increased employee quality of work as reflected in the positive responses from patients during the evaluation period.
Duke University Hospital has performed a tremendous work of designing and operationalizing its balanced scorecard visible through the positive results realized. The balanced scorecard developed and used by the hospital observes key quality management concepts. It is formulated as a continuous process, measures different elements in the operation perspective and patient perspective such that all stakeholders are able to review data important to their individual performance and recommend improvements. The balanced scorecard designed by the hospital employs the innovation and care aspects of quality. It covers the management of the product, which is quality care for patients, it covers the quality of service presented by nurses and seeks to expand the hospital’s operations by targeting and increase in the patients’ volume. As a result, the strategy has demonstrated that focus on quality ultimately leads to increased productivity and profitability for the organization. Moreover, the balanced scorecard has taken care of the community as it identifies staffs and patients as key stakeholders of the hospital’s success. To be sustainable, the hospital included regular review of the scorecard as part of the framework and includes a regular investment on the improvement of each perspective of the scorecard (CQI, n.d.).