NARMC Commanders

Balanced
NARMC Conference
Scorecard
Commanders –
– Balanced
Balanced Scorecard
Workbook
Conference Scorecard

Top to Bottom
Strategic
Vision

BSC

Bottom to Top
Implementation

LTC Judy Harger, NARMC

NARMCClinical
ClinicalOperations
Operations
USA MEDCOM
Workshop Manual April 2001
 Balanced Scorecard

COURSE DESCRIPTION:
An introduction to the Balanced Scorecard designed to
introduce the concepts and critical success factors of
developing and implementing a measurement system
using the BSC strategy planning tool principles and
methods.

COURSE OBJECTIVES:
• Achieve working knowledge of the Balanced Scorecard
concepts
• Understand components for successful implementation
of measurement and BSC strategy
• Demonstrate learning by developing a BSC strategy tool
and an analysis of implementation for an organization.
 Balanced Scorecard

COURSE OUTCOMES
By the end of the course, participants will be able to
demonstrate learning in
• Balanced Scorecard Four Perspectives
• SWOT Analysis
• Cause and effect linkages between strategies and
measures
• Performance Drivers
• Leading and lagging indicators
• Elements for an effective scorecard
• Critical Processes for effective implementation of a
Balanced Scorecard
 Balanced Scorecard

COURSE REFERENCES:

The Balanced Scorecard, Translating Strategy Into

Action
Robert S. Kaplan and David P. Norton
Harvard Business School Press. 1996

The Strategy Focused Organization, How Balanced

Scorecard Companies Thrive In The New Business
Environment
Robert S. Kaplan and David P. Norton
Harvard Business School Press. 2001
EVENING SCHEDULE:
National Graduate School - Friday, 14 June 2002

Military Folk Non-Military Folk TOPIC:

1800 - 1830 6:00 - 6:30 Introductions/ Class Organization/ Sign-IN

1830 - 1845 6:30 - 6:45 Biography/ Camels/ Flag

1845 - 1930 6:45 - 7:30 Balanced Scorecard 101

1930 - 1945 7:30 - 7:45 Break

1945 - 2000 7:45 - 8:00 SWOT/ Company Assignments

FRIDAY:
2000 - 2030 8:00 - 8:30 Student Task: SWOT Development
Transition to BSC Perspectives
Thunderstorms/Hail
Illustrate Linkage 75 High/ 62 Low
Pre-liminary Strategic Objective Terminology
Light wind/Fog
2030 - 2040 8:30 - 8:40 Company Report:

2040 - 2050 8:40 - 8:50 Company Report:

2050 - 2100 8:50 - 9:00 Company Report:

2100 - 2115 9:00 - 9:15 Break

2115 - 2145 9:15 - 9:45 Strategic Objectives: Themes /Goals

Objective Statements
Introduction to Measures and Targets
Initiatives

2145 - 2200 9:45 - 10:00 Summation

SATURDAY:
Secure Classroom Mostly Cloudy
STUDENT TASK: One page paper - two if absolutely necessary - discussing the following: 79 High/60 Low
Application of Balanced Scorecard in your organization
... Dynamic climate of the organization NE Wind 5-10
… Obstacles to change
… Organizational benefit
… Vision of the future with BSC applied
“ I’ve always reckoned that a camel is a horse designed by a committee …”
- Freddie Laker
 Quality Gurus
1996
Deming BALANCED
Morgensen SCORECARD
Ronald
Fisher Shewart Feigenbaum Akao Crosby
Kano

1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

Mizuno Tribus David Norton

Sarasohn Taguchi Robert Kaplan
G.S. Radford
Juran
Ishikawa 2001 STRATEGY-FOCUSED
ORGANIZATION
 Balanced Scorecard
1. Shewhart: Significance of Variation/Control of Quality
2. Sarasohn: Basic beliefs – Commitment,Ownership,
Feedback
3. Deming: Plan, Do, Check, Act
14 Point Theory of Management
Seven Deadly Diseases and Obstacles
4. Juran: Juran Trilogy-Quality=Planning,Control,Improvement
5. Ishikawa: Fish Bone Diagram: Cause and Effect
Analysis
6. Taguchi: Six Sigma – Improvement of Processes and Products
7. Norton/
Kaplan: The Balanced Scorecard
The Strategy Focused Organization
 Balanced Scorecard
“A management system that can channel the energies,
abilities, and specific knowledge held by people
throughout the organization toward achieving long-term
strategic goals … to guide current performance and target
future performance … using measures in four categories:
financial performance, customer knowledge, internal
business processes, and learning and growth.”

“… a robust learning system for testing, gaining feedback on,

and updating the organization’s strategy.”

“… invest in the long term rather than

manage the bottom line to pump up short- Success !
term gains.”
 Ultimate Goal, to Become a:
STRATEGY-FOCUSED
ORGANIZATION
1

2 5

3 4
Balanced Scorecard Provides the Bridge from Strategy
to Operations
MISSION
Why we exist
VALUES
What’s important to us
VISION
What we want to be
STRATEGY
Our game plan
BALANCED SCORECARD
Implementation & Focus
STRATEGIC INITIATIVES
What we need to do
PERSONAL OBJECTIVES
What I need to do

DESIRED STRATEGIC OUTCOMES

Satisfied Delighted Efficient and Effective Motivated & Prepared

SHAREHOLDERS CUSTOMERS PROCESSES WORKFORCE

Financial Customers Internal Process Learning & Growth

A FRAMEWORK TO TRANSLATE STRATEGY INTO OPERATIONAL TERMS

FINANCIAL:
To succeed financially,
how should we appear
to our shareholders?

INTERNAL
BUSINESS
CUSTOMER: MISSION
PROCESSES:
To achieve our vision, VISION To satisfy our
how should we appear
to our customers?
STRATEGY shareholders and
customers, what
business processes
must we excel at?
LEARNING AND
GROWTH:
To achieve our vision
how will we sustain
our ability to
change and improve?
 The Balanced Scorecard Focuses an
Organization on its Strategy
The Premise
Measurement Motivates

 The creation of value, consistent with the mission, is the overarching purpose of organizations

 Strategy defines the unique organization approach to creating value

Conclusion
Strategy
 A measurement system designed to influence behavior should describe the strategy
 A good Balanced Scorecard describes the organization strategy
Balanced
Scorecard
 Integrate your SWOT and Your Long Range
Strategic Plan Into Your Strategy Map
STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
Quality of Care (3) Poor Access to own PCM Base Realignment and Closure (1) Payment for Patient Travel
Command Communication-External Rural Location Fixed Customer Base Lose Customer to Alternative Healthcare
Lack of Local Healthcare Competition Culture for 'Free' Care (1) Outreach Programs Aggressive Other Healthcare Systems
Reputation Facility Layout (4) Real Estate TRICARE for life
CUSTOMER & Facilities/Infrastructure Poorly Defined Customer Needs (2) Population Health (5)
STAKEHOLDER Poorly Defined Customer Wants Telemedicine
Strengthen Relationship w/ Lead Agent & Post (1)
Strengthen relationship with Installation

Long
LONG
Technology and Equipment Communication (1) Metric Refinement & Development for Export TMA Lead Agent (1)
JCAHO (1) Data Collection and Analysis (2) Externally Imposed Metrics (2)
Access to Data Sources Template Management
ADP Technology Skills Business Case Analysis (3)
INTERNAL MTF Staff Versus MCSC Staff Relationships Process Management (1)
PROCESS Clinical Practice Guidelines (1) Specialty Referral
Staffing Unresponsive to Short Term Demand (1)

Range
Non Interfaced IT

Internal Clinical Training/Certification
Leadership
RANGE
Untimely Organization Performance Feedback (1)
Internal Training/Certification
Quality of Reporting and Reports (4)
Lack of Priority Process (4)
Uneven Distribution of Work (5)
Staff Retention Education Center Isolation Nursing Shortage (1)
Staff Satisfaction (2) Export Training Programs Limited and Expensive Labor Pool

Strategic
Dedicated and Stable Workforce Low Volume Competency Job Share/Exhange with Other MTFs CPO Rules (1)

STRATEGIC
PA Education (clinical training) Orientation of New Providers Basic Training Increase
LEARNING & Promotion Opportunities (1)
GROWTH Educational Opportunity for Staff
Insufficient SW/ADP Training
Insufficient SW/ADP Staff (1)
Poor Job Performance Feedback
Skill Sustainment (3)

Plan
Satisfactory Budget Fixed Funding but Increasing Costs MCSC Nurse Triage System Unstable Budget

PLAN
Known Budget Distribution of End of Year Funds
FINANCIAL

S W O T Theme Theme
1 Theme
2 Theme
3 4
Financial
Customer
L&G Internal

Vision: The Integrated and Responsive System of Choice For Quality Health Services in
Service of the Army at Home and Abroad 19 JAN 01
Project and Sustain A Healthy and Medically Protected Force DoD/Army/Soldiers

Financial
Protected From Lower Army’s
Healthy Disease and Medically Related

Customer / Stakeholder
Soldiers Injury Costs

Deploy a Trained and Equipped Medical Force That Supports Army Transformation DoD/Army

Financial
Return Reduce Cost of

Mission
Trained Flexible Smaller
Soldiers to Ownership of the
AMEDD Medical Forces Footprint
Duty Deployable Force

Manage and Promote the Health of the Soldier Family and the Military Family Beneficiary/DoD/Army

Financial
Improve the Health Timely, Friendly, Maximize Total (MCSC+
Satisfy Patients
of the Population Compassionate Competent Direct) System Efficiency
and Their
Care
Families

Provide State of the Art Deploy solutions for Continually

Health Risk Assessments AMEDD to support Manage the Care of Our Improve
Army Beneficiaries Operations

Internal/Process
and Countermeasures
Transformation • Improve Marketing of
Army Healthcare
• Fast, complete, and effective • Better alignment of resources with population requirements System

SWOT analysis presents an opportunity to

monitoring and reporting of medical • Leverage capabilities of • Better, safer patient care processes • Reduce variation in
threats and the force’s health and institutional AMEDD • Simpler, more streamlined access to care clinical and business
fitness • Better integration with network providers systems of care practices across the
• Efficient, effective development, • Best training programs for our caregivers AMEDD
application and evaluation of health and • Fast, accurate
• Compassionate disposition of the medically unfit soldier

express Strengths, Weaknesses, Opportunities,

fitness standards analysis, forecasting,
modeling and planning
& Growth
Learning

Enable Mission Readiness

Build and Maintain

and Threats in the context of the Balanced

Recruit Leverage Information Leverage all Sources of Medical Reliable Facility and
& Retain a Quality Management and and Non-Medical Technologies to Installation
AMEDD Force Information Technology Generate High Value Solutions Infrastructure

Achieve Fiscal Accountability

Financial

Scorecard Predict and Secure

Levels of Funding
Required
Operate Within
Budget
 AMEDD Strategic Goal
#3:
Manage the Care of the Developing the AMEDD BSC
Soldier and the Military
Family
Strategic Theme:
Focus on our Customers

Strategic Objectives:
Custome
r Quality,
Compassionate Eliminate the
Care Hassle Factor

Internal Strategic Objective Measure Target Initiative

Process
% 82% Increase #
Safe appointments of MTFs
Patient Care Streamline
Streamline meeting with web
Access to Care
Access to Care TRICARE access to
access appointment
Learning standards s
&
Growth

Train the Medical

Force
Recruit & Retain a Strategic Measures: Targets: Initiatives:
Quality Medical
Force Objectives How The stated Breakthroug
: What success or level of h action
Financial
the failure performanc programs
Operate within Budget strategy is (performan e or rate of initiated to
Predict & Secure Levels
of Funding Required trying to ce) against improveme achieve
achieve. objectives nt desired targets
is
monitored.
 Balanced Scorecard

“I sensed that the person actually doing the job probably

knows more about the job than anyone else and is therefore
the one person best suited to improve it…”

Allan Morgensen
1928
SWOT
 1. SWOT Analysis
• Strengths: (These are internal to your organization)
- What are your advantages?
- What do you do well?
- What are your core competencies?
• Weaknesses: (These are internal to your organization)
– What could be improved?
– What is done badly?
– What conditions lead to poor performance?
• Opportunities: (These are external to your organization)
– Where are the outside conditions that you can turn to your advantage?
– What are the interesting trends?
• Threats: (These are external to your organization)
– What obstacles do you face?
– What is your competition doing?
– Are the required specifications for your job,products or services
changing?
 1. Think of the SWOT Issues in Terms of
the BSC Perspectives
• What are my financial strengths,
weaknesses, opportunities and StrengthsWeaknesses
Opportunities Threats
threats?

Internal Customer Financial

• From the customer’s perspective,
what are my strengths, weaknesses,
opportunities and threats?
• Internally, consider your
processes; what are the strengths,
weaknesses, opportunities and
threats?
• From my employee’s perspective

L&G
regarding culture, technical
infrastructure and competencies/
skills, what are my strengths,
weaknesses, opportunities and
threats?
PIONEER CEDAR MILL AND PENCIL MANUFACTURING, LTD

Pioneer, California

Located in foothills of the magnificent Sierra Nevada Mountain Range,

this company is one of three U.S. companies producing cedar shafts for
pencils. This traditional company operating since the Gold Rush in
1849, hires local “highlander, mountain folk” as employees but recent
trends have for urban migration have challenged there workforce
population. Additionally, environmental regulations and re-foresting
requirements have put a stranglehold on financial growth and resources.
Competition is encroaching from overseas interests. The company is a
major employment and finance tax base for this rural community.
 MEGA-GOVERNMENT COMPREHENSIVE
HEALTHCARE

A non-profit, tax supported governnmental agency having an

immense, changing beneficiary population which requires
enrollment and dependent upon fiscal legislation and gross
national product for program growth. Historically, this
agency has been flush with staff and fully funded but now
faces the challenge to streamline to accommodate budget shifts
and popular opinion as to effectiveness and efficiency.
AREA 51 SPACE-AGE COMPUTER SCIENCE DEVELOPMENT
CORPORATION

New in the computer science, e-business community, this company

has the challenge to make a quick, efficient, forward innovative
approach to communication. It’s goal is to bring the marketing and
capital engendered business community together with the
opportunities discovered in space industry. Its challenges involve
government regulation, security, high-cost equipment, education of
personnel, attracting competent workforce and selling their product
and service.
 SWOT:
BSC Perspectives STRENGTHS WEAKNESSES OPPORTUNITIES THREATS

RESOURCES
FINANCIAL/
CUSTOMER
LEARNING &
GROWTH
PROCESSES
INTERNAL
 1. SWOT + Scorecard = “SWOT CARD”
The “Swot card” presents an opportunity to combine the SWOT analysis
with BSC leveraging the four perspectives as defined with in the
Scorecard to build a “bridge” between the two concepts.

StrengthsWeaknesses
Opportunities Threats Theme 1 Theme 2 Theme 3 Theme 4
Internal Customer Financial
L&G
 Learn and Improve
Strategy Maps and Scorecards

Financial Customer/Stakeholder
Vision: The Integrated and Responsive System of Choice For Quality Health Services in
Service of the Army at Home and Abroad Version: 1 DEC
Project and Sustain a Healthy
and Medically Protected Force
Provide a force that is
Deploy a Trained and Equipped
Medical Force
Deploy a trained and
Manage and Promote the Health
of the Soldier Family and the Military Family
Provide improved
Obj Me Goa Initi
ativ
healthy, fit and protected access to high

ecti asu ls
equipped medical force that
from injury and disease supports Army quality health care
C1 transformation C3 at the lowest
possible cost C5

Achieving Fiscal Accountability

Accurately predict and secure levels
Demonstrate true
“ROI” for
shareholders I4 Reduce the Operate within budget F3
ves res es
of funding required F1 Army’s medically
related costs F5

AMEDD
Maximize total (MCSC+

Measure and Manage

Direct) system efficiency F7

Develop and provide Improve

Improve quality

Internal/Process
state of the art risk beneficiary
Improve countermeasures I 1 Design, man, train, of care I10
equip, and sustain relationship
monitoring and
reporting on fully capable management
medical threats Do predictive medical systems I6 I11
and the force’s modeling of health Align resources with
health fitness L1 readiness and changing mission
threats I5 Leverage and population I9

Strategy
capabilities of the Increase access
institutional I8
Align Support the
AMEDD to support Improve at managed
incentives to development and
operational care contract
support implementation of
medicine I7 negotiation and
prevention L2 health and fitness
standards I 14 management I13

Continuously Improve Operations and Processes

Formulate and Align

Develop the capability for Improve marketing of Identify and

fast, accurate analysis, c Army Healthcare
the implement best
forecasting, modeling and System I16 practices L5
planning I15

L e a rn in g &
Enable Mission Readiness

G ro w th
Leverage AMEDD Leverage information
Optimize facility
Recruit, train and and installation
science to engage management and
retain a quality medical
the DoD/Army in information technology infrastructure L7
shaping policy I2 force L6
L4

Financial Customer/Stakeholder
Vision: The Integrated and Responsive System of Choice For Quality Health Services in
Service of the Army at Home and Abroad Version: 1 DEC
Project and Sustain a Healthy Deploy a Trained and Equipped Manage and Promote the Health
and Medically Protected Force
Provide a force that is
healthy, fit and protected
Medical Force
Deploy a trained and
equipped medical force that
of the Soldier Family and the Military Family
Provide improved
access to high
Obj Me Goa Initi

MSC
ativ
from injury and disease

ecti asu ls
supports Army quality health care
C1 transformation C3 at the lowest
possible cost C5

Achieving Fiscal Accountability

Accurately predict and secure levels
of funding required F1
Demonstrate true
“ROI” for
shareholders I4 Reduce the
Army’s medically
Operate within budget F3 ves res es
related costs F5

Maximize total (MCSC+

Direct) system efficiency F7

Strategic
Develop and provide Improve
Improve quality

Internal/Process
state of the art risk beneficiary
Improve countermeasures I 1 Design, man, train, of care I10
equip, and sustain relationship
monitoring and
reporting on fully capable management
medical threats Do predictive medical systems I6 I11
and the force’s modeling of health Align resources with
health fitness L1 readiness and changing mission
threats I5 Leverage and population I9
capabilities of the Increase access
institutional I8
Align Support the
AMEDD to support Improve at managed
incentives to development and
operational care contract
support

Plans
implementation of negotiation and
prevention L2 health and fitness medicine I7
standards I 14 management I13

Continuously Improve Operations and Processes

Develop the capability for Improve marketing of Identify and
fast, accurate analysis, c Army Healthcare
the implement best
forecasting, modeling and System I16 practices L5
planning I15
L e a rn in g &

Enable Mission Readiness

G ro w th

Leverage AMEDD Leverage information

Optimize facility
Recruit, train and and installation
science to engage management and
retain a quality medical
the DoD/Army in information technology infrastructure L7
shaping policy I2 force L6
L4

Financial Customer/Stakeholder

Vision: The Integrated and Responsive System of Choice For Quality Health Services in
Service of the Army at Home and Abroad Version: 1 DEC
Project and Sustain a Healthy Deploy a Trained and Equipped Manage and Promote the Health
and Medically Protected Force
Provide a force that is
Medical Force
Deploy a trained and
of the Soldier Family and the Military Family
Provide improved Obj Me Goa Initi

Unit
healthy, fit and protected equipped medical force that access to high

ativ
from injury and disease

ecti asu ls
supports Army quality health care
C1 transformation C3 at the lowest
possible cost C5

Achieving Fiscal Accountability

Accurately predict and secure levels
of funding required F1
Demonstrate true
“ROI” for
shareholders I4 Reduce the
Army’s medically
Operate within budget F3 ves res es
related costs F5

Maximize total (MCSC+

Strategic
Direct) system efficiency F7

Develop and provide Improve

Improve quality
Internal/Process

state of the art risk beneficiary

Improve countermeasures I 1 Design, man, train, of care I10
equip, and sustain relationship
monitoring and
reporting on fully capable management
medical threats Do predictive medical systems I6 I11
and the force’s modeling of health Align resources with
health fitness L1 readiness and changing mission
threats I5 Leverage and population I9
capabilities of the Increase access
institutional I8
Align Support the
AMEDD to support Improve at managed
incentives to

Plans
development and care contract
support implementation of operational
medicine I7 negotiation and
prevention L2 health and fitness
standards I 14 management I13

Continuously Improve Operations and Processes

Develop the capability for Improve marketing of Identify and
fast, accurate analysis, c Army Healthcare
the implement best
forecasting, modeling and System I16 practices L5
planning I15
L e a rn in g &

Enable Mission Readiness

G ro w th

Leverage AMEDD Leverage information

Optimize facility
Recruit, train and and installation
science to engage management and
retain a quality medical
the DoD/Army in information technology infrastructure L7
shaping policy I2 force L6
L4

Objec Meas Goals Initiat Aligned functional,

Functional,
tives ures ives

team, and individual

Team, performance
Individual objectives,
Plans measures, goals,
and action plans

Communicate and Allocate

 How Do You Measure Strategy?
Strategy
The Balanced Scorecard
converts strategy into an
integrated system of
“To be
Customer Perspective
ObjectivesMeasures Targets Initiatives objectives, measures,
targets, and initiatives
successful, Image
what
customer/sta Service

Customer/
ke-holder
needs must
Price/Cost
defined across four
organizational perspectives
we serve?”

Stakeholde “To satisfy

our
Internal Perspective
Objectives Measures Targets Initiatives

r customers/ Cycle
Time
stakeholders,

Internal/Process in which
internal
business
Quality

processes Productivity
must we
excel?"
Learning Perspective
Objectives Measures Targets Initiatives
" To
achieve our Market

Learning process Innovation

goals, how Continuous
must our Learning
organization
and Growth learn and
innovate?”
Intellectual
Assets

Financial Perspective
"To meet our Objectives Measures Targets Initiatives
organizational Profit-
goals, what ability

Financial resources will

we need and
which
Growt
h
Share-
constraints holder
must we Value
consider?”
 Balanced Scorecard

Measurement System Goals –

1. Understand current state

2. Manage by fact
3. Encourage communication
4. Promote focus and alignment
 XYZ Measures
Actual monthly expenses as a
Linkages % of budgeted expenses
Draft (8/7/99)
Financial Actual project expenses as a
Customer % of budgeted expenses
Process
Learning&Growth
Critical Perspective Measure Customer satisfaction
rating
% of projects with defined Reporting process -
and managed project plans project status
% of project solutions
implemented within required
quality and performance levels
Needs assessment gap - % XYZ training scheduled
required vs. actual skills & completed
required
% increase in XYZ skill
% XYZ employees levels
w/completed skills analysis
XYZ employee
satisfaction
% identified XYZ positions w/
completed competency models
XYZ turnover rate
Earned value analysis -
Cost and schedule variances
% of customers and suppliers
identified with defined
interdependencies
% of required meetings
attended
NBI Process - % NBI’s
with assigned and engaged
XYZ representative
Prioritization - # of projects
with established priority
Increase XYZ process
effectiveness &
efficiencies
% of XYZ employees with
access to required tools
Cost Model defined and
implemented
% of scope changes effecting
schedule and budget
Scope Management -
# of scope change requests
Resource Allocation - cycle
time to fill requests for
resource
Resource Planning - staffing
levels available to fill
requests for resource
CMM levels achieved
# of Best Practices
implemented
# of Best Practices
identified
# of Post Implementation
Reviews conducted
 Balanced Scorecard
Measurement Systems – Top Ten Problem List
10. Data Overload
9. Short-Term Focus
8. Lack of Detail
7. Measuring What’s Easy
6. Measuring What Doesn’t Matter
5. Focus on Behavior not Process Results
4. Measures that Discourage Teamwork
3. Customer, What Customer?
2. Wrong Performance Drivers
1. Doing It Because Everyone Else Is !
 Balanced Scorecard
MEASUREMENT LIFE CYCLE:

Select Specify Plan for Collect

Measure Definitions Deployment Data

Validate Analyze Take

Report
Data Appropriate
Action

Retire
Measure
 Integrated Strategic Management
System (SMS)
National
Security Strategy R&A
National Military
Strategy

Joint Vision
Business
2020 Balanced Case
Vision Scorecard -Objectives Analysis
The Army Plan
Army Goals -Measures Business
Transformation
Strategy -Targets Plans
Strategy AMEDD -Initiatives AMEDD
MHS 3-5yrs MSC 0-1.5yrs
Strategic Plan MSC
Optimization Subordinate Subordinate

TSG
Vision
Mission Budget POM
Values
 AMEDD
BALANCED
SCORECARD
 Army Medical Department Strategy Map 19 Apr 01
Project and Sustain A Healthy and Medically Protected Force DoD/Army/Soldiers

Financial
Protected From Lower Army’s Medically
Healthy Soldiers
Disease and Injury Related Costs

Deploy a Trained and Equipped Medical Force That Supports Army Transformation DoD/Army
Mission Customer /

Financial
Stakeholder

Reduce Cost of
Flexible Medical
Trained Medics Smaller Footprint Ownership of the
Forces
Deployable Force

Manage the Care of the Soldier and the Military Family Beneficiary/DoD/Army

Financial
Quality, Passion for Healthy Patients Maximize Total
Eliminate the
Compassionate Eliminating and Families Are (MCSC+ Direct)
Hassle Factor
Care Wasted Time #1 System Efficiency

Focus on Our Customers

Provide State of Expedient,

Products to Market to
the Art Health Risk Compassionate Return Soldiers to
Support Army Safe Patient Care
Assessments and Disposition of Medically Duty
Internal/

Transformation
Process

Countermeasures Unfit Soldiers

Monitor Medical Leverage Implement Clinical Align Resources

Streamline Access
Threats and the Capabilities of and Business Best With Population
to Care
Fitness of the Force Institutional AMEDD Practices Requirements
Internal

Develop, Fast Maintain a

Leverage Science and Accurate Analysis, Reliable Facility Integrate Direct and Market the Army
Technology Forecasting, Modeling and Installation Network Care Healthcare System
and Planning Infrastructure

Enable Mission Readiness

& Growth
Learning

Recruit Leverage Information

& Retain a Quality Develop Leaders Train the Medical Force Management and Information
AMEDD Force Technology

Achieve Fiscal Responsibility

Financial

Predict and Secure

Levels of Funding Operate Within Budget
Required
 NARMC
BALANCED
SCORECARD
 North Atlantic Regional Medical Command
Serving the Area of our Colonial Beginnings and the Nation’s
Capitol with Pride, Competence, and Character

Vision Statement
America’s leading Regional health system focused on readiness and academic excellence
while providing well-coordinated care for the world’s best Army.
Building health care teams and medical leaders of competence and
character for a lifetime of service to the nation

Our Operating Principles

Patients First! Customer focus
Committed leaders
Organized teamwork
Strong learning Ethic
Open, honest communication
Dignity and respect in all relations
Caring and concern for all our staff
Excellence in resource stewardship
Data-driven, information smart,
involved clinical decision makers

“Building Trust, Earning Respect”

MG Timboe's 2002 Priority Efforts Aligned with NARMC Balanced Scorecard Strategic Objectives:

Mobilization Issues:
SRP + Mob Hospital

Building Trust & Earning Respect

48CSH: Proj ect and Sustain A Healthy and Medically Protected Force DoD/Army/Soldiers
Protected from NARMC
Parking Healthy
Soldiers C1 Disease and
Lower Army’s
Medica lly Re lated
Injury C2
Lot Costs F1 10 SEP 01
Deploy a Trained and Equipped Medical Force That Supports Army Transformation DoD/Army
Trained Reduc e Cost of
Ready Active and
Mission/ Customer /

PROFIS Ownershi p of the

Electrical issues Reserve Units C3
Soldiers C4 Depl oyab le Force F2
Stakeholder

Manage the Health of the Soldier & the Military Family

WRAMC + Installation Healthy Patients
Quality Eliminate the Passion for
Beneficiary/DoD/Army
DINPACS
Compassionate Meet Line Cdr’s Hassle Factor Eliminating
and Families are #1 C8 Optimize Total (MCSC+
Service C6 Expectations Wasted Time
C5 C9 Direct) System Efficiency F3
Fund Ft Drum C7
MTF’s
Prov ide Command and Control
Renovations Innovative
Resourc es to
Support Missi ons
Clear Direction
Solutions C11 F4
and Priorities C10
38 + 91 Funds Web-based
a Patients First! C ustomer Foc us
appointing
Improve
Monitor, Ana lyze Manage the WRAMC Expedite Ensure Quali ty Facilitate Marketing
Bldg 11Lobby and In terpret
Regional P M Da ta
91W Transition Garrison
Operations
Medical
Disposition of
Ensure Quali ty Improve
Access IP5
Education &
Training
of Army Healthcare
IP2 Patien t Care IP4 System IP6
the Soldier IP3
b IP1 IP21 Programs I P19
Internal/Process

Bldg 40
Plan & Imple ment
a Medical Force Improve Training Facilitate M TF Improve M TF
Integrate Direct and
Care Coordination:
and Readiness Manage Data Quali ty Business Process
Accreditations
Progress
Protection
Program IP7 Management I P8 I P9
Program IP10 IP11
Network Care I P12
Case Mgmt issues
Leverage NARMC
Leverage Informa tion Identi fy and Align Resources wi th
WRAMC OR's Capabilities to Support
Institu tional A MEDD I P13
Improve Facili ties’
Infrastructure IP14
Improve Equ ipmen t
Acquisition I P15 Management /In forma tion
Technology IP16
Imple ment Best Changing Mission and
Population I P18
Practices I P17
Retention Em + Off
WRAMC ICU's Strong Lear ning Ethic and C om mitte d Leaders
& Growth
Learning

Assist Commanders Demonstrate Caring &

WRAMC to Recruit, & Reta in a
Quality Force L1
Ensure a Trained
Workforce L2
Develop Leaders L3 Respect For Sold iers &
Civilian Workforce L4

Lab-deep
Excellence in Resource Ste wardshi p
base
Financial

Predict and Secure

WRAMC Levels of Resources
Required F5
Operate with in
Budget F6

Warehouse
WRAMC c I'm not clear as to w hat these are
Lobby Pharmacy automation/ Military Cancer Institute or w here to put them:
finish robotics
WRAMC ICPB FP ??? VSM 21 ???
Parking Vaccination ???
 Supporting Theme: Excellence in Resource
Strategic Theme: Stewardship
Objective Statement Measures NARMC
PRIORITY
Target FY 01
Predict and Secure F-5 Predict and secure
Levels of Resources #18
Required F5 levels of resources
required by producing
Financial

timely, accurate, and

prospective business case
Operate within analyses, Budget #18
Budget F6
Estimate, POM, and Mid-
year Review submissions.

F-6 Ensure all MTFs

operate within a budget
commensurate with
mission and buying power.
 Building Trust & Earning Respect
REGIONALProject
COMMAND AND CONTROL DEPLOY A HEALTHY FORCE DEPLOY A MEDICAL FORCE PROVIDE & MANAGEDoD/Army/Soldiers
and Sustain A Healthy and Medically Protected Force
HEALTHCARE CARING FOR SOLDIERS & STAFF
Protected Ready Active Eliminate
Clear from Disease the Hassle Plan & Implement
Direction and and Reserve
and Injury C2 Units C3 Factor a Medical Force
Priorities C10 C8 Protection
Healthy Program IP7
Mission/ Customer /

Soldiers C1 Healthy
Monitor, Analyze
Patients and
Stakeholder

and Interpret Quality

Regional PM Data Families are #1 Compassiona
IP1 Trained
C5 te Service C6
PROFIS
Soldiers C4 Facilitate MTF
Accreditations
Passion for IP9
Improve Facilities’
Eliminating Infrastructure IP14
Wasted Time Meet Line
C9 Cdr’s
Expectation
s
C7 Improve Access
IP5

Facilitate Marketing
Manage Data Quality Expedite Medical
Leverage NARMC Ensure Quality of Army Healthcare
Program IP10 Disposition of the
Capabilities to Support Patient Care IP4 System IP6
Internal/Process

Soldier IP3
Institutional AMEDD
IP13
Improve MTF
Optimize Total (MCSC+ Business
Direct) System Efficiency Process IP11 Identify and Integrate Direct and
Implement Best Network Care IP12
F3
Practices IP17

Improve Improve
Leverage Information Equipment
Management/Information WRAMC
Acquisition IP15 Garrison
Technology IP16
Operations
IP21 Ensure Quality
Education &
Manage the Training
91W Transition Improve Training
Learnin

Growth

and Readiness Programs IP19

Assist Commanders IP2 Innovative Management IP8 Demonstrate Caring & Develop Leaders
to Recruit, & Retain Ensure a Trained Solutions
g&

Respect For Soldiers & L3

a Quality Force L1 Workforce L2 C11 Civilian Workforce L4

Align Resources with

Changing Mission and
Financial

Operate within Population IP18

Lower Army’s Budget F6 Predict and Secure Resources to Reduce Cost of
Medically Related Levels of Resources Support Missions Ownership of the
Costs F1 Required F5 F4 Deployable Force F2
A Word About Data…….
 “Building Trust, Earning Respect”
North Atlantic Regional Medical Command

Balanced Scorecard Initiatives FY 2002

ACoS Objective Champion: (Legend):

Operations Logistics Personne

l
Clinical Resource Management Garrison

Information Management/Information Technology

1. Review and update Mobilization Support 7. Develop Comprehensive Clinical Business

Plans and medical annex at RMC PPP/PSP
installations
2. Conduct Readiness and AT Site Support
Conferences
3. Improve PROFIS Readiness/Tasking
Management
4. Improve monitoring and reporting of
security threats
5. Improve implementation of Army Training
Management System : CTG, Long-range
calendar, MRR workshop
6. Maximize training opportunities
Plan maximizing MTF utilization
8. Improve predictability and stability of
patient care manpower
9. Implement Data Quality Program: validate
and monitor DQ process and reports
10. Implement process to monitor and improve
DoD Patient Safety Program compliance
11. Develop and implement Complex Care
Coordination Plan
12. Improve quality management program
compliance in areas of JCAHO, CCQAS,
HIPAA, and Patient Safety Program

Fully Implement Balanced Scorecard in NARMC

 Building A Balanced Scorecard

Major Premise: Each organization is unique

1. Preparation: Define the appropriate business unit

2. Interviews: First Round - Senior manager/s with BSC intro and
background materials
3. Executive Workshop: First Round - Top management develop
scorecard “Linking Measurements to Strategy”
4. Interviews: Second Round - Tentative Scorecard
5. Executive Workshop: Second Round attend by groups middle
managers, champions, measures, targets
6. Executive Workshop: Third Round: Executive Final consensus
7. Implementation Team
 ALTITUDE
SPEED
YAW

PITCH
DIRECTION
 Three Financial Themes:

• Revenue Growth and Mix

• Cost Reduction / Productivity Improvement

• Asset Utilization / Investment Strategy

 Three Core Customer Value Propositions:

The key concept for understanding drivers of the

core measurements of satisfaction, acquisition,
retention, and market and account share

• Product / Service Attributes

• Customer Relationship

• Image and Reputation

 INTERNAL BUSINESS PROCESS

Critical internal business processes in which the

organization must excel:

• Deliver on the value propositions of customers in

targeted market segments

• Satisfy shareholder expectations of excellent returns

Measures should be focused on internal

process that will have the greatest impact
on customer satisfaction and achieving
organization’s objectives
 Organizational Learning and Growth come from
three principal sources:

• People

• Systems

• Organizational Procedures

Financial, customer and internal process perspectives

of BSC will reveal large gaps between existing
capabilities of people, systems, and procedures and
what will be required to achieve targets for
breakthrough performance
1. Properly constructed BSC should tell the story of the
organizations strategy - single strategy

2. The measurement system should make relationship among

objectives explicit so they can be managed and validated

3. Articulate the “theory of business” - competitive excellence

4. Cause and effect should pervade all four perspectives

5. Short term targets

6. Too many measures = too comp;icated for organization to

absorb
 Return on Capital Employed
FINANCIAL

Customer Loyalty
CUSTOMER

On-Time Delivery

INTERNAL Process Quality Process Cycle Time

LEARNING Employee Skills

& GROWTH
 Cause and Effect Linkages
Example
Financial Improve Returns
•ROI
•Revenue Mix Broaden Revenue Mix
•Growth
Customer
Customer Satisfaction
•Satisfaction
•Retention
Increase Customer Confidence
•Relationships
Process
•Dev Cycle
Understand Customer Develop the
•Hrs w/Cust Segments Offering
•New Prod Rev

L & G
•Rev/employee Employee Satisfaction
•Job Coverage
•Goals Aligned Improve Customer Information Broaden Skills Reward Alignment
 Organizations should have hundreds, thousands of
measures that they can monitor to ensure that they are
functioning as expected and that will signal when
corrective action must be taken.

BUT these are not the drivers of business’ competitive

success as are outcome and performance driver
measures on BSC

Diagnostic Measures: monitor whether business “in

control”

Strategic Measures: Define a strategy designed for

competitive excellence, direct focus
Lead Indicators: Focus management Attention on the
Drivers of Performance

e.g. Claims Quality Audit Staff Development

Plan

Lag Indicators: Core Outcome Measures

e.g. Claims Frequency Staff Productivity

Claims Severity
Loss Ratio
To succeed
Linking Perspectives To satisfy our
financially, how Financial customers, what
should we Profitability
Cash Flow business
appear to our Profits
processes must
stakeholders? Growth Sales Growth
we excel at?
Shareholder ROI, ROE
Value & ROA

Customer Processes
Cycle Time Turn Around
Response Cycle Time
Accuracy Time to Mkt

Service On Time Quality Error Rates

Retention Turnover
Quality Error Rates

Organization
To achieve our To achieve our
vision, how
New Prod/
vision, how will
Innovation
Sales
should we Cont. Improve
Time Reduction we sustain our
appear to our Intellectual ability to change
customers? Assets Mkt Value
& improve?
Source: Professor. Kaplan and David P. Norton
 BSC CHAMPIONS/LEAD

1. Responsible for specific Strategic Objective

2. Identify required coordination

3. Assign subordinate support and tasks

Data Sources
Collection Method
Data Availibility
Frequency of reporting
Initiatives Supporting Strategic Objective

4.. Monitor progress to target

MEASUREMENT SYSTEM
TEMPLATES
NARMC Balanced Scorecard Measurement System Template As of Date:

A. Strategic Objective: B. Objective Statement:

C. Status: Red( ) Amber( ) Green( ) D. Report Frequency:

E. Lead(Champion): F. Supporting Cast:

G. Description/Value:

H. BSC Perspective: Mission/Customer ( ) Internal Process ( ) Learning/Growth ( ) Financial ( )

Ia. MEASURE: Days lost Ib. MEASURE:Processing time

Ja. Data : Source Elements Jb. Data : Source Elements

Ka. Collection Method: Kb. Collection Method:

La. Availability: Ma. Retention/Monitoring: Lb. Availability: Mb. Retention/Monitoring:

( ) Available ( ) Weekly ( ) Available ( ) Weekly

PRESENTATION: N. Data Provided By:

O. Required Coordination:

P. Calculation/Format:

Q.

R. Target/Goal S. FY 2001 Actual T. FY 2002 Forecast U. FY 2002 Actual to date V. FY 2003 Forecast

LTC Harger DSN:662-3641

 Scorecard “Health Check”
Balance of Measures

Aligned to Strategic Objectives

Clear Linkages Between Measures

Measures are Non-Conflicting

Capability to Drive Change

 Scorecard “Health Check”
Comprehensive Definitions Established

Measures are “Actionable” and Tied to

Initiatives

Baseline and Targets Identified

Results are Analyzed and Reported

Support and Ownership Established

 LTC Judy Harger
North Atlantic Regional Medical Command
Chief Quality Management, Clinical Operations
Comm: (202)782-3641 DSN: 662-3641
Judy.Harger@na.amedd.army.mil

“soon to be” … as of 1 September 2002

Judy Harger (LTC-Retired)

North Atlantic Regional Medical Command
Quality Standards Coordinator
Same contact numbers and email
Thank you

The End!