Best Practice - Balanced Scorecard

2012-2013 JMSS Balanced Scorecard Results Relevant leadership theory has changed – masses of people do not bend to the will of the leader anymore. They join leaders only when they share a common vision, such as in the pursuit of a goal. Goals can empower and generate emotional commitment. Goals link leaders and followers. Can you remember a situation where you sensed the commitment of a team from a mile away? Most likely, they had a shared vision or goal.

The problem with goals is the randomness with which some work and some don’t. If our goals don’t cause us to work harder, or longer, or smarter, or to spend our time differently, or to acquire new skills or all of these, then they are useless.

Simply setting goals doesn’t do anything. Setting goals in a way that changes people’s behavior is the purpose behind a Balanced Scorecard.

The Balanced Scorecard at John Maloney Southside (JMSS) Health Clinic was created after success of team huddles. Two goals were set: 1) decrease the time it takes to get test and lab results and 2) maintain daily huddles.

Decreasing Cycle Time for Results JMSS had a backlog of tests, labs, and consults. The operational measure was actually called “Backlog”—defined as those referrals where the needed information was not received after 6 months. Another operational measure, “Hotlist”, was defined as referrals that were under 6 months of age. What would motivate the staff to take responsibility to resolve these referrals that numbered 308 and 361 respectively on December 31, 2012?

In February 2013, a scoreboard was displayed in a common area. The scorecard tracked two things – the number of backlog and hotlist referrals, and the implementation of daily huddles. The MA’s agreed to resolve at least 2 referrals/day, which required follow up phone calls to the patient and provider.

Then, the office manager tracked progress and posted feedback on the data wall.

Points (“dots”) were used as rewards. Slowly at first, the referral backlog began to chip away. Then, in a surge of energy, the remaining referrals were resolved within 2 weeks. To date, the clinic has maintained both backlog and hotlist referrals at zero. As one upper level manager put it, “A miracle occurred at JMSS”.

Huddles In April 2012, the MA and providers began meeting for 10 minutes, looking over the schedule for the next day. This enabled the team pre-plan the patient appointments. In June 2012, a follow-up study in proved that every 10 minutes spent in pre-planning for the patient visit saved the physician 45-60 minutes the following day. Staff members began to embrace the huddle as a way to make their job easier. Once this was known, it was desired that all providers hold a daily huddle, even new providers (as staff turnover occurred). Managers set the goal and the MA’s turn-in daily huddle notes for accountability. To date, 100% of provider teams hold daily huddles. Rarely is a day missed.

Two words describe the value of a balanced scoreboard – motivation and maintenance. A recent study reported that managers often cite execution as the most important factor shaping outcomes in the busy operation of a health clinic.

Apparently, a Balanced Scorecard increased JMSS’s ability to execute goals. It provided motivation to change and the maintenance to cement the change in place.