Implementing a balanced scorecard approach at an NHS library service: Kostoris Library

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Merry Horton
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1 Implementing a balanced scorecard approach at an NHS library service: Kostoris Library Steve Glover, Education Business Manager Anne Webb, Library Operations Manager

2 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

3 The balanced scorecard Kaplan and Norton (1992, 1996) Kaplan and Norton s heralded publication introducing the balanced scorecard was published in the Harvard Business Review in 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

4 The balanced scorecard Kaplan and Norton (1992, 1996) Looks at the organisation s performance from four perspectives Customer perspective Internal business processes perspective Learning & growth perspective Financial

5 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.

6 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 Children s 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).

7 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

8 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.

9 Health sector use of the BSC in the literature (2) Duke University Children s 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.

10 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.

11 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

12 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

13 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

16 Developing the Library Scorecard 1. Need a clear library strategy 2. Consider the 4 perspectives developed by Kaplan and Norton Customer perspective Internal business processes perspective Learning & growth perspective Financial 3. Consider what to communicate to stakeholders 4. Select measures which reflect activities important to the strategic goals of the library Map to strategic objectives Use measures for which data is obtainable 5. Include all staff

17 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

18 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

19 Perspectives 1. Customer How do we want to appear to our customers? Document Delivery Services: turnaround vs satisfied requests Value Added: Service delivery and feedback 2. Financial How should we appear to our stakeholders Budget control? Cost effectiveness - cost/use? Return on investment

20 Customer Perspective

21 Perspectives 3. Internal Business Processes Operational and functional processes Making resources available Books and online resources Stock processing 4. Learning and Growth Individual level Service level

22 Internal Processes Perspective

23 BSC figures

24 Library Balanced Score Card Dashboard

25 School of Oncology Strategy Library Strategy Library Action Plan Marketing Plan Outreach Plan Balanced Score Card Library Operations Team Meeting Library Staff Meeting

26 Pro s and con s Advantages 1. Staff involvement- reported in staff team meetings 2. Highlights successes and stresses -used in operational team meetings 3. Easy to see where problems develop 4. Easy to demonstrate activity in relation to strategy 5. Uses indicators that matter 6. Performance on developmental activity rather than just current processes Disadvantages 1. Difficult to get metrics right 2. Need to consider balance 3. It takes time to implement 4. Requires commitment 5. Resistance 6. Difficult to select un biased measures

27 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

28 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

29 References (1) Grant, L., and Proctor, T. (2011). Measuring quality: how to empower staff to take control. Nursing Times, 107(7), pp Gumbus, A. (2005). Introducing the balanced scorecard: creating metrics to measure performance. Journal of Management Education, 29(4), pp 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), Kaplan, R.S., and Norton, D.P. (1992). The balanced scorecard: measures that drive performance. Harvard Business Review, 70(1), pp Kaplan, R.S., and Norton, D.P. (1996a). Using the balanced scorecard as a strategic management system. Harvard Business Review, 17(1), pp Kaplan, R.S., and Norton, D.P. (1996b), The balanced scorecard: translating strategy into action, Boston: Harvard Business School Press.

30 References (2) McLean, S., and Mahaffey, S. (2000). Implementing a surgical balanced scorecard. Surgical Services Management. pp Meliones J., (2000). Saving money, saving lives. Harvard Business Review, 78, pp Rimar, S., and Garstka, S.J. (1999). The balanced scorecard : development and implementation in an academic clinical department. Academic Medicine, 74(2), pp Self, J. (2003). From values to metrics: implementation of the balanced scorecard at a university library. Performance Measurement and Metrics, 4(2), pp Self, J. (2004). Metrics and management: applying the results of the balanced scorecard. Performance Measurement and Metrics, 5(3), pp 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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