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Implementing a balanced scorecard approach at an NHS library


Implementing a balanced scorecard approach at an NHS library service: Kostoris Library Steve Glover, Education Business Manager Anne Webb, Library Operations Manager – PowerPoint PPT presentation

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Title: Implementing a balanced scorecard approach at an NHS library

Implementing a balanced scorecard approach at an
NHS library serviceKostoris Library
  • Steve Glover, Education Business Manager
  • Anne Webb, Library Operations Manager

  • What is a balanced scorecard?
  • Why did we introduce the BSC at the library
  • 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

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

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

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

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).

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

Health sector use of the BSC in the literature
  • 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
  • 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.

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.

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.

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

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

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

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

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

  • 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

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

Internal Processes Perspective
BSC figures
Library Balanced Score Card Dashboard
School of Oncology Strategy
Library Strategy
Marketing Plan
Outreach Plan
Library Action Plan
Balanced Score Card
Library Operations Team Meeting
Library Staff Meeting
Pros and cons
  • Advantages
  • Staff involvement- reported in staff team
  • Highlights successes and stresses -used in
    operational team meetings
  • Easy to see where problems develop
  • Easy to demonstrate activity in relation to
  • 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

Summary (1)
  • Hardest part of designing a BSC is defining the
  • 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

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
  • Reviewed regularly
  • Be inclusive to all staff in the department
  • Be a tool for measurement as well as management

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),
  • 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.

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),
  • 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.
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