Health-care provider adopts balanced scorecard tool

TORONTO – Some U.S. hospitals may be getting better at measuring their performance, but they share Canada’s overall failure to make the proper investments in IT, experts told an audience of health-care providers Tuesday.

At an event hosted by SAS Canada to discuss best practices in Ontario’s health-care system, an executive from Brigham and Women’s Hospital in Boston discussed how his organization was using business intelligence tools to offer “balanced scorecarding.” This is a system to clarify, manage and gauge the success of a company’s efforts to turn strategy into action. Dr. Michael Gustafson, vice-president of clinical excellence at Brigham Women’s Hospital (BWH), said the organization started rolling out SAS’s Balanced Scorecard product about three years ago and is still in the process of adding users.

BWH, which was formed 25 years ago through the merger of four regional hospitals, employs more than 1,000 doctors and has 50 operating rooms, Gustafson said. As a highly decentralized teaching and research hospital, he said, managers were struggling to pore over more than 40 reports on various parts of its operation each month, and balanced scorecarding was seen as a way of whittling down that volume of data. It was also an attempt to more easily correlate data and do trend analysis, which wasn’t possible previously.

“We were sobered by how little of the information we were generating was reaching the people who needed it the most,” said Gustafson, who said BWH began piloting the software in its nursing, surgery and finance departments. Some of these early adopters had created their own “paper dashboards” with Excel, he said. The software had to not only replace those but accommodate data feeds from dozens of proprietary databases and off-the-shelf packages such as PeopleSoft HR.

BWH broke down the kind of things it wanted to measure into four areas, Gustafson said. These included service excellence; quality and efficiency; commitment to people, research and training; and financial performance. Unlike private sector organizations, he said, his team moved the financial performance portion to the bottom of its list of priorities. The hospital created a strategy map that showed how improvement in one of these areas naturally improved the area above it. Better financial performance, for example, tends to allow more money for people, research and training.

“We came up with about 30 performance measures for each area,” Gustafson said, acknowledging that this greatly exceeds the number recommended by balanced scorecard experts. “We just didn’t want to leave anything out.”

BWH now produces more than 231 scorecards for its surgical operations, 93 for nursing and 21 for medicine. The next step, Gustafson said, was incorporating data from more individual database programs and integrating it with other legacy systems.

Despite this, the U.S. is making slow progress with IT in much of its operations, said Dr. Kenneth Kizer, president and CEO of the National Quality Forum in Washington, D.C.

“This is the most information-intense activity that human beings have ever engaged in,” Kizer said, “yet we are 40 years behind other sectors, such as banking, and I can’t say I’m encouraged that things are going to change any time soon . . . people are waiting for this big cash infusion. It just ain’t coming.”

Dr. Vince DiNinno, vice-president of medical services for the Palliser Health Region in Alberta, agreed. “Technology is not recognized in the funding structure,” he said.

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