Implementing a balanced scorecard as a strategic management tool in a long-term care organization

Abstract

Background: The Capital Care Group, the largest public sector continuing care organization in Canada, had no ready access to information on its own performance and therefore was limited in its pursuit of evidence-informed decision-making. To remedy this, it was decided to introduce a balanced scorecard.

Assessment of problem: A literature review was conducted together with interviews with 10 other health care organizations which had implemented balanced scorecards. With this information, a workshop was held that resulted in a framework and about 120 potential indicators. Subsequently the number of indicators was reduced to 29, using pre-determined criteria.

Results: Development of a corporate balanced scorecard facilitated executive strategic thinking and clarified the organization's strategic direction. In parallel, scorecards were developed at the level of care centres. These had a common core of indicators, plus some site-specific ones. Development of the corporate scorecard took three years and an additional six months for the care centre scorecards.

Strategies for change: A formal implementation plan has been accepted by the executive team. Key to this is communicating to staff the role of scorecards for strategic management and not just performance measurement. Traditional thinking needs to change from a short-term operational focus to long-term strategy. In addition, champions need to be identified in each care centre and they need to be networked together. Finally, the scorecard is being integrated into existing operational management as a routine component together with resources to support its use.

Lessons and messages: The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient resources must be assigned. However, success will ultimately depend on the culture of the organization being appropriate and receptive.