Implementing a balanced scorecard approach at an NHS library

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Implementing a balanced scorecard approach at an
NHS library serviceKostoris Library

• Steve Glover, Education Business Manager
• Anne Webb, Library Operations Manager

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Background

• What is a balanced scorecard?
• Why did we introduce the BSC at the library
  service?
• What did the literature tell us?
• How does the BSC work?
• Design and implementation
• How does it work in practice?
• Tips for designing a BSC system

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The balanced scorecard

• Kaplan and Norton (1992, 1996)
• Kaplan and Nortons heralded publication
  introducing the balanced scorecard was published
  in the Harvard Business Review in 1992.
• Initially taken up by the private sector, the
  balanced scorecard approach has gained a wider
  acceptance by non-profit, charitable, and
  government public sector organisations in their
  drive for greater efficiencies, and deriving best
  value for the use of public funds

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The balanced scorecard

• Kaplan and Norton (1992, 1996)
• Looks at the organisations performance from four
  perspectives
• Customer perspective
• Internal business processes perspective
• Learning growth perspective
• Financial

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Balance Performance

• Successful organisations use performance
  measurement systems that include elements beyond
  the purely financial (Gumbus 2005).
• Within health care and public sector
  organisations traditional performance management
  methods are financially employed through
  budgetary negotiation (Verzola et al 2009).
• These traditional methods rarely link easily with
  health care performance and therefore can lack
  clarity.

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Balance Performance

• The four perspectives of the balanced scorecard
  are of equal importance to the overall success of
  the system in managing the alignment of strategy
  and achieving performance. The Chief Medical
  Director at Duke Childrens Hospital in Durham,
  North Carolina, sums it up as follows
• If you sacrifice too much in one quadrant to
  satisfy another, your organization as a whole in
  thrown out of balance. We could, for example cut
  costs to improve to financial quadrant by firing
  half the staff, but that would hurt quality of
  service. (McLean and Mahaffrey, 2000).

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BSC in non-Profit organisations

• Profit not always the organisations primary
  mission
• Highly accountable to their funders such as
  donors or government bodies
• Accountable to regulator bodies (e.g. Monitor,
  CQC, GMC, NHSLA)
• PMS can improve accountability, alignment to
  strategy, and improved financial performance
• Business can learn from non-profit sectors

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Health sector use of the BSC in the literature
(1)

• Huang and colleagues (2004) reported the improved
  performance of a Taiwanese emergency department
  after implementing the BSC system
• Improved performance by comparing evaluations of
  laboratory test efficiency rates, staff and
  patient satisfaction scores before and after
  implementation.
• All measures improved, as part of the internal
  processes measured, blood and urine test results
  were returned faster and with more accuracy.
• As a result patient complaints dropped and
  satisfaction scores improved.

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Health sector use of the BSC in the literature (2)

• Duke University Childrens Hospital introduced
  the system and reported significant improvements
  in results in terms of operating margins and the
  quality of care (Meliones, 2000)
• Grant and Proctor (2011) published a review of
  using the balanced scorecard in a clinical
  setting to increase the quality of nursing care
• system is easy to use because staff can see at
  a glance where improvements are needed due to
  the traffic light system employed to indicate
  performance against set tolerances.

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Health sector use of the BSC in the literature (3)

• Verzola and colleagues (2009) reported on the
  evaluation of the balanced scorecard implemented
  in two departments of the St Anna University
  Hospital, Ferrara, Italy.
• The balanced scorecard offered a common language
  for health professionals from a multidisciplinary
  range of personnel such as nurses, allied health
  professionals, medical staff and administrators.
  

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Health sector use of the BSC in the literature (4)

• Rimar and Garstka (1999) developed a scorecard
  for a Yale University Medical School clinical
  academic department.
• They recognised that changes in health care
  financing would have significant impact on the
  revenues and the mission of medical education
• - Lessons learned
• - Faculty involvement
• - Identifying appropriate metrics

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Balanced Scorecard in Library Services

• University of Virginia library service (Self,
  2003 2004)
• Focused management on activities that made a
  difference
• Key performance measures aligned to organisations
  strategy
• Value for money
• Customers satisfaction

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How does the BSC work?

• Uses traffic light system to show performance
• Gives an at-a-glance view
• Can be reviewed by non-experts
• Uses set tolerances to define performance
• Shows changes in performance over time
• Allows staff input

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Developing the Library Scorecard

• Need a clear library strategy
• Consider the 4 perspectives developed by Kaplan
  and Norton
• Customer perspective
• Internal business processes perspective
• Learning growth perspective
• Financial
• Consider what to communicate to stakeholders
• Select measures which reflect activities
  important to the strategic goals of the library
• Map to strategic objectives
• Use measures for which data is obtainable
• Include all staff

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Library Strategy

• Provide access to high quality peer-reviewed
  information
• To maintain a repository of bibliographic data
• Develop the online library services
• Provide access to a professionally qualified
  librarian
• Provide innovative current awareness services..
  
• To provide value for money..
• To provide excellent customer service and monitor
  feedback

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Key Performance Areas

• Stock monitoring and development
• Compliance with BMA core oncology list
• Online library resources (e-books)
• Online library resources (e-journals)
• Literature searching
• Current awareness services
• Information skills training sessions
• Processing new book stock and resources
• Library publications and leaflets
• Website quality
• Repository development - latest staff research
  articles captured and submitted
• Outreach services
• Marketing and promotion

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Perspectives

• Customer
• How do we want to appear to our customers?
• Document Delivery Services turnaround vs
  satisfied requests
• Value Added Service delivery and feedback
• Financial
• How should we appear to our stakeholders
• Budget control?
• Cost effectiveness - cost/use?
• Return on investment

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Customer Perspective
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Perspectives

• Internal Business Processes
• Operational and functional processes
• Making resources available
• Books and online resources
• Stock processing
• Learning and Growth
• Individual level
• Service level

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Internal Processes Perspective
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BSC figures
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Library Balanced Score Card Dashboard
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School of Oncology Strategy
Library Strategy
Marketing Plan
Outreach Plan
Library Action Plan
Balanced Score Card
Library Operations Team Meeting
Library Staff Meeting
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Pros and cons

• Advantages
• Staff involvement- reported in staff team
  meetings
• Highlights successes and stresses -used in
  operational team meetings
• Easy to see where problems develop
• Easy to demonstrate activity in relation to
  strategy
• Uses indicators that matter
• Performance on developmental activity rather than
  just current processes

• Disadvantages
• Difficult to get metrics right
• Need to consider balance
• It takes time to implement
• Requires commitment
• Resistance
• Difficult to select un biased measures

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Summary (1)

• Hardest part of designing a BSC is defining the
  metrics
• Use Key performance indicators
• Try and use data that you are already collecting
• Tool for the department
• Involve all staff in contributing to the BSC
• Review at team meetings
• Fluid document

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Summary (2)

• BSC should reflected the four perspectives
• Design of the BSC should focus on activities
  related to the library strategy
• BSC should become integral to the agenda for team
  meetings
• Reviewed regularly
• Be inclusive to all staff in the department
• Be a tool for measurement as well as management

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References (1)

• Grant, L., and Proctor, T. (2011). Measuring
  quality how to empower staff to take control.
  Nursing Times, 107(7), pp.22-25.
• Gumbus, A. (2005). Introducing the balanced
  scorecard creating metrics to measure
  performance. Journal of Management Education,
  29(4), pp.617-630.
• Huang, S.H., Chen, P.L., Yang, M.C., Chang, W.Y.,
  and Lee, H.J. (2004). Using a balanced scorecard
  to improve the performance of an emergency
  department. Nursing Economics, 22(3),140-146.
• Kaplan, R.S., and Norton, D.P. (1992). The
  balanced scorecard measures that drive
  performance. Harvard Business Review, 70(1),
  pp.71-79.
• Kaplan, R.S., and Norton, D.P. (1996a). Using the
  balanced scorecard as a strategic management
  system. Harvard Business Review, 17(1), pp.75-85.
  
• Kaplan, R.S., and Norton, D.P. (1996b), The
  balanced scorecard translating strategy into
  action, Boston Harvard Business School Press.

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References (2)

• McLean, S., and Mahaffey, S. (2000). Implementing
  a surgical balanced scorecard. Surgical Services
  Management. pp.48-52.
• Meliones J., (2000). Saving money, saving lives.
  Harvard Business Review, 78, pp.57-65.
• Rimar, S., and Garstka, S.J. (1999). The
  balanced scorecard development and
  implementation in an academic clinical
  department. Academic Medicine, 74(2), pp.114-122.
• Self, J. (2003). From values to metrics
  implementation of the balanced scorecard at a
  university library. Performance Measurement and
  Metrics, 4(2), pp.57-63.
• Self, J. (2004). Metrics and management applying
  the results of the balanced scorecard.
  Performance Measurement and Metrics, 5(3),
  pp.101-105.
• Verzola, A., Bentivegna, R., Carandina, G.,
  Trevisani, L., Gregorio, P., Mandini, A.
  (2009). Multidimensional evaluation of
  performance experimental application of the
  balanced scorecard in Ferrara University
  Hospital. Cost Effectiveness and Resource
  Allocation, 7(15), pp.1-8.