Part III: United General Hospital Balanced Scorecard Creation

United General Hospital Balanced Scorecard Creation – United General Hospital (UGH) is an acute–care facility that offers healthcare services to a suburban in Mid-western community that enquires to improve its financial management. The hospital has been operating at a loss. However, it is sufficiently funding necessitating the hospital executives to look for a way to excel in customer care and nurse retention in line with the set financial goals…

Instructions:

Before submitting your Assessment, carefully review the rubric. This is the same rubric the assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.

Rubric

Access the following to complete this Assessment:

• United General Hospital Patient Privacy Case Study
• Productivity Metrics Dashboard
• Academic Writing Expectations Checklist

To begin, read the scenario below; the “United General Hospital Emergency Room Case Study” and other documents provided; and the “Productivity Metrics Dashboard.” Then, complete Parts I–III.

Scenario:You have been hired as a consultant to increase productivity in United General Hospital’s emergency department. Your consulting engagement entails evaluating productivity metrics for the emergency room (ER), creating a balanced scorecard to measure the department’s performance, and then presenting recommendations to the leaders of the emergency department.

This Assessment has three parts. Click each of the items below to complete this Assessment.

Part I: Productivity Metrics (Word Document)

As a first step in your consulting engagement, you review Ron’s experience in the ER. Using information from the case study, evaluate Ron’s experience and summarize your findings against national standards as follows (4-5 pages):

• Identify 6-8 activities or processes carried out during Ron’s visit to United General. Enter the 6-8 activities or processes and their duration in the “Productivity Metrics Dashboard.” (attachment in the instructions)
  • Each of the 6 to 8 activities in the chart need to have completed data for the Observed Time, National Average, and Differential OT vs NA. (You will complete the Acceptable differential data for the 5 activities or processes you will discuss below.)
    • Include the sources for all data in the sources tab in the “Productivity Metrics Dashboard.”
• Write an analysis of activities and processes that create inefficiency as follows:
  • Identify five of the activities or processes from the case study/ included in your dashboard that create inefficiency in the emergency department.
  • Provide a rationale for your selection of the five activities or processes. Include cited material and References to support your assertions.
  • Identify any discrepancies and outline reasons why discrepancies exist.
• Write an analysis of acceptable differentials for the five activities or processes as follows:
  • Using benchmarks determined by the Centers for Medicare and Medicaid Services, identify the national averages/benchmarks for five activities or processes you selected.
    • Enter the national averages/benchmarks in the “Productivity Metrics Dashboard.”
  • Determine an acceptable differential to the national benchmark for each of the 5 activities or processes and enter the differentials into the “Productivity Metrics Dashboard.”
  • Explain the methodology you used to determine acceptable differentials for each of the metrics for these five activities.

Part II: Balanced Scorecard Methodology (Slide Presentation)

The next step in your consulting engagement is creating a balanced scorecard but, first, you must convince the executive committee that the balanced scorecard method is effective. Several members of the executive committee are not familiar with the process. An important part of your role is to educate them. You decide to show them a sample balanced scorecard for an emergency department.

• Create a 5 to a 7-slide presentation that explains the balanced scorecard methodology, including at least two strengths and two limitations, and the benefits of using the balanced scorecard methodology in United General Hospital’s emergency department.
  • Include a critique of the hospital’s productivity metrics results and any limitations of the current data collection process and/or metrics being used for the scorecard.

Part III: Balanced Scorecard Creation (Word Document)

After you explain the balanced scorecard methodology, the board and chief executive officer (CEO) want you to create a balanced scorecard for the emergency department at United General.

• Create a balanced scorecard for United General’s emergency department. Can be completed in an image or graphic type display. (up to 2 pages)
  • Include both quantitative and qualitative metrics.
• Explain why you selected these metrics for United General and how you identified the targets. (4-6 pages)
  • A defense of best practices used for productivity metrics dashboard data collection, analysis/interpretation, and action planning.
  • Recommend a high-level process to collect, track, and measure data for the emergency department’s productivity metrics.

Solution

Part III: United General Hospital Balanced Scorecard Creation

Introduction

United General Hospital (UGH) is an acute–care facility that offers healthcare services to a suburban in Mid-western community that enquires to improve its financial management. The hospital has been operating at a loss. However, it is sufficiently funding necessitating the hospital executives to look for a way to excel in customer care and nurse retention in line with the set financial goals. The Balanced Scorecard approach is bound to help UGH enhance fiscal responsibility while simultaneously improving major service delivery areas (Khiew et al., 2017). This community, not-for-profit acute care hospital boasts 42 beds, more than 260 workers, and 55 active registered nurses representing six subspecialties. Every year, it is approximated that UGH offers services to 25 000 patient care visits, including 2 000 admissions. About 23 000 total outpatient visits with over 7 200 emergency department visits and 3 500 clinic visits. There are also 720 same-day surgery visits and 3 800 outpatient rehabilitation visits.

The Challenge

Like other hospitals, UGH faces a myriad of challenges with financial constraints attributed to local and state funding changes and increasing outpatient care resulting in long wait times for patients to receive healthcare as they go through the various activities of ER. Therefore, the hospital executives need to address the financial realities of inadequate funding and the operational environment. Nevertheless, the hospital remains steadfast in its commitment to excellence in patient care (Wu et al., 2019). 

The Solution

The balanced scorecard will give UGH a framework that connects clinical outcomes of high quality, expert clinical care professionals, satisfied patients, nursing staff, and physicians, and growth in volume and market share to financial measures. The designer of the balanced scorecard began by roping in management groups to define a course to financial health. The board of directors, healthcare staff, and hospital administration have collaborated if future success is to be realized. The team’s collaboration will merge and create a singular vision for the hospital’s future premised on the four perspectives of customer, financial, internal, processes m and learning and growth opportunities. For example, as part of reducing the extended wait times by patients for services in the ER as they seek to have a registration, copayment, wait time for a nurse, wait time for physician all the way to follow up appointment scheduling. These activities mean the hospital executive should implement an Employee of the Month Award winners to nurture a patient care system that translates to excellent customer services using a series of measurable activities known as the Service contract. Ansell et al. (2017) note that besides financial health, other aspects captured by the balanced scorecard are organizational health, quality, process improvement, volume, and market share growth.

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The Results

           The Balanced scorecard would give the hospital a shared language necessary for a healthcare facility that comprises many skilled, diverse professionals. It is projected that within 12 months of the BSC implementation, there will be reduced wait times for activities offered in the ER and lower staff turnover rates in the ED. Similarly, patient satisfaction and customer preference will increase. In addition, performance improvement is expected in several areas as the ED department and the hospital, in general, meets the set financial goals. These include staying below the allocated staffing budget and realize a supply chain savings of $ 75 000.

A Balanced Scorecard for United General’s Emergency Department

The fiscal Year 2019 -2020

1^st Quarterly Results of July-September of the Year Completed

Perspective	Objective	Measure	Actuals	Actuals	Notes
			Baseline 7/1/2019	Cumulative By 9/30/2019 and Target by 6/30/2020
Financial(F1)	Effective management of budgetary resources)	Maintain control  of local resources through monthly budget monitoring	0%	100% Stay within the allocated budget
Internal Processes (IP-1)	Improve internal and external collaboration	Actively participate in new on and off ED emergency department partners	0	5 16 by 6//30. /020
(IP-2)	Continuously improve UGH-ED disaster planning and response programs	Stay connected to local, regional, state and federal, and international EM professionals	0	6 And target  24
Customers ( C1)	Proactively enhance the preparedness of the ER	Current processes improved per year.	0	11 and target of 96	Quarterly goal not met
(C2)	Inform other departments on time	UGH-ER drills and exercises completed and evaluated	0	One and target of 16	Quarterly goal not met
(C3)	Deliver high-quality service	Rating of UGH –ER training with a rating of 4 or 5 on a 5 point scale	90%	100% And the target of 90%	Highest score to date. However, results not reliable as only 1 customer replied to the post-training survey.
(C4)Expand  ER servicesCreate additional rooms, programs, or events within the unit that promote sound emergency management40 and a target of 8 Learning and Growth (L&G-1)Improve staff professional development opportunities developmentNumber of orders  participating in local regional and national conferences, seminars, and training workshops043 And a target of 100The goal for the quarter was exceeded. This, however, was the average of three staff results

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Explanation on Why the Metrics for UGH-ER Were Selected and How the Targets Were Identified

The UGH Emergency Department healthcare team is continuously looking for ways to enhance and therefore utilizes a scorecard to monitor current progress. Several areas have been selected for central focus, including fiscal accountability, internal processes, customer service, and workers’ learning and growth. Since the beginning of the third millennium, the ER unit head and the hospital’s management team have used the nationally recognized scorecard methodology to set, record, and measure the ED progress. They do so when tracking the goals and objectives related to ER’s primary activities. The BSC presented above is for the current quarterly balanced scorecard. It is instructive to note that the results were posted within two weeks of the strategies for the next quarter to address issues arising after being reported for the last three months of the fiscal year 2019-2021.

One of the reasons the ER reports and posts its quarterly results is to keep track of the progress and help determine if any changes are required to address inadequacies or shortcomings. Additionally, the ER teamwork with the staff stationed their together with stakeholders to evaluate and reassess existing measures to adjust the set targets and goals. At the same time, ensure that the program is on schedule in meeting the needs of individuals seeking healthcare services, most of whom are patients. The strategic objectives of the productivity parameters cover the actions that the ER team has to implement into its daily activities to realize improvement strategies. The four perspectives of financial customer, internal processes, and learning and growth opportunities break down the abstract concepts of the hospital’s mission and vision into actionable steps.

Beginning with a financial perspective, the key objectives are to lower costs, increase the department’s s profitability, and increase the hospital’s revenue base. As stipulated in the BSC (F1), the objective is to manage budgetary resources effectively. To achieve the objective, it is anticipated that the ER will utilize resources cost-effectively and efficiently. The productivity measure is to maintain control of all financial resources through monthly budget monitoring. The identified measure champion for this measure is also the measure owner and is ED head. The baseline actuals on July 1, 2019, are 0%, while the cumulative actuals are 100%. In terms of fiscal discipline, the ER targets within the budget allocated and allowance.

The second perspective after the financial one is internal processes. The objective under this perspective is two abbreviated as IP 1 and IP 2. Objective IP1 envisages enhancement of internal and external collaborations whose measure is ED active participation in new or additional on- and off ED management partners. As such, the UGH-ER purposes of increasing limited staff activities involving partners in departmental planning and implementation and, likewise, remaining connected to local, regional, state, national, and international ER participation.

The measure is attendance at the event. Baseline line actuals are 0%, while the cumulative actual is 5. The set targets for the quarters that follow are 4, 8, 12, and 6. The following internal process objective is to reduce or decrease bottlenecks within the ED to improve the delivery of services during registration, copayment processing, and wait time for nurses and physicians. The measure is existing UGH-ER processes improved per year as if the financial perspective the measure champion is the ED unit head and her staff. The baseline actuals for this measure for the selected quarter is zero with a cumulative actual of 11. The other set targets for September 30, 2019, are 24, 48, 72, and 96. Realizing these objectives would result in increased process efficiency and lower cycle time, which translates to decreased patient wait time in the ED. Unfortunately, as per the BSC, this quarterly goal, was not met. Several reasons can be used to account for this, but the main one is because UGH-ER staffing levels were reduced by a third due to a vacancy in the critical position.

Four objectives were identifiable under the customer perspective, but the linking thread that joins them seeks to decrease patient wait time as they seek ER services. Therefore, the following overriding link is the improvement of customer retention. The first of four objectives of this perspective is to enhance the preparedness of the ED by ensuring that ER staff is equipped with extra tools to execute their disaster response and recovery missions and activities effectively. Three measures will be used to evaluate this objective. One, ER drills and exercises completed will be used to evaluate. The baseline actuals are zero and a cumulative actual of one. This is the other quarterly goal that was not met due to understaffing levels falling by a third due to vacancy in the critical care position. The second measure will be the % of actual emergence disaster exercises, events, or drills. The third measure under that objective will increase the ER management team participation.

            The second objective, abbreviated as C2, is to inform patients and other parties quickly and accurately. That means the ER staff will communicate the right thing at the right thing to the right people. This will further reduce patient wait time in the ER, as there is no communication breakdown to cause delays. The measure to use here is the number of times webpage and Facebook uploaded with fresh and updated content. The baseline actuals are 0 and cumulative actuals of 32. C3 seeks to deliver high-quality service by ensuring the services provided in the ED meet or exceed the customer’s needs. The result of such a gesture is increased patient satisfaction meaning many would recommend this hospital to their friends; the measure to evaluate its productivity is the number of times UGH-ER customers rate the facility at 5/5 or 4 /4 on 5 points rating scale. The baseline actuals are 0%, while the cumulative actuals stand at 92.

            The fourth and last objective under the customer perspective is an expansion of the ER program outreach. It is expected that the ER will work to improve ongoing hospital emergency management customer and partner messages through proactive activities. Two measures are selected for C4, namely the number of new venues programs, activities, or events within the hospital setting that promote sound emergency management by the hospital community. The baseline actuals were 4, while the cumulative was 0. The quarterly goal was not met after the UGH –ER staffing levels fell by third due to a vacancy in the critical area. The second measure for objective C4 is the number of customers or partners receiving emergency training. The baseline actuals for this objective while cumulative actuals stood at 341. Like the other objectives that were not met, the cause was a reduction in staffing levels in the ER after a vacancy in the critical area. 

The fourth perspective covers learning and growth, whose objective was to improve staff professional development opportunities by providing access to expanded avenues and possibilities. The measure was the number of hours participating in local, regional, and national conferences. The actuals baseline was 0 and a cumulative actual of 43. IT is essential to observe that this goal set for the quarter in context was exceeded. This is because it only captures the average of three staff who ranged from 0- 27 hours.

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Defense of Best Practices Used For Productivity Metrics Dashboard Data Collection, Analysis Interpretation, and Action Planning

The ED staff at UGH have to understand how one measures success in strategic planning while acknowledging that performance measures and key performance indicators can sometimes be challenging. The best practice for productivity metrics is to define what one wants to measure. To be more specific, the measures are further categorized as activity measures that capture a percentage, number, currency, and activities or processes. Next are outcome measures that address progress against a defined and specific outcome. The third is progress measure, where the project’s progress is addressed as a percentage in terms of how far it is complete, deliverable; the last of these measures is target structure, where a numeric result is measured against a date (Jarvis, 2018). The next best practice is for the ER staff to define its target, outline the data source, and define an owner and the tracking frequency.

Recommended High-Level Process to Collect, Track, and Measure Data for the Emergency Department’s Productivity Metrics

According to Ehrenstein et al. (2019), the measurement for performance indicators commences with a question and fast moves to data collection. The process of data collection has three significant steps beginning with data generation. During this step, all the clinician processes and opportunities require the professional enters information into the medical record or a management information system. Step two involves data abstraction, where the data is harvested from the information system. The cited researchers report that more than 33% of the US EDs exclusively use paper-based record-keeping, meaning interoperability of computers remains a crucial challenge to many hospitals UGH included. The last step in the data abstraction process is systematic validation, even as a second abstractor conducts a random spot check to ensure the data extracted is accurate. The third and final step is data reporting. Important decisions capture how much to report and from whom. At this juncture, planning decision calls for alignment of the data with the goals at the unit, departmental ad administrative level.

Conclusion

In conclusion, this essay has established that the balanced scorecard methodology approach can help ensure that valid key performance indicators can be monitored. Since the KPI is based on objectives, a KPI would not exist unless it is related to an objective. Most importantly, every hospital department should review its BSC at least every six months. These regular reviews mean the hospital or department in context remains competitive and keeps the staff on top of the defined KPIs.

References

Ansell, D., Crispo, J. A., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times for primary care appointments: a systematic review. BMC health services research, 17(1), 1-9.

Austin, E. E., Blakely, B., Tufanaru, C., Selwood, A., Braithwaite, J., & Clay-Williams, R. (2020). Strategies to measure and improve emergency department performance: a scoping review. Scandinavian journal of trauma, resuscitation and emergency medicine, 28(1), 1-14.

Ehrenstein, V., Kharrazi, H., Lehmann, H., & Taylor, C. O. (2019). Obtaining Data From Electronic Health Records. In Tools and Technologies for Registry Interoperability, Registries for Evaluating Patient Outcomes: A User’s Guide, 3rd Edition, Addendum 2 [Internet]. Agency for Healthcare Research and Quality (US).

Jarvis, P. R. E. (2016). Improving emergency department patient flow. Clinical and experimental emergency medicine, 3(2), 63.

Khiew, K. F., Chen, M. C., Shia, B. C., & Pan, C. H. (2017). Adapting the Balanced Scorecard into the Healthcare Industry: A Literature Review, New Insight, and Future Directions. Open Journal of Business and Management, 5(4), 611-623.

Wu, X., Li, S., Xu, N., Wu, D., & Zhang, X. (2019). Establishing a balanced scorecard measurement system for integrated care organizations in China. The International Journal of health planning and management, 34(2), 672-692.

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