BALANCED SCORECARD FOR ACUTE MENTAL HEALTH NURSING

A Balanced Scorecard for Acute Mental Health Nursing

A Balanced Scorecard for Acute Mental Health Nursing

Introduction

The Balanced Scorecard (BSC) is a performance-monitoring framework that originated in the business sector but has more recently been applied to health services. The province of England is using the BSC approach to monitor quality of inpatient care in five service areas. Feasibility of the scorecard framework for each area has been assessed using a standard approach. This paper reports results of the feasibility study for the mental health sector, focusing on three issues: framework relevance, underlying strategic goals and indicator selection. Based on a literature review and extensive stakeholder input, the BSC quadrant structure was recommended with some modifications, and indicators were selected that aligned with provincial mental health reform policy goals. The mental health report has completed two cycles of reporting, and has received good support from the field. (Schiff , 2000, 70)

The Balanced Scorecard (BSC) is an approach increasingly used to monitor performance of healthcare systems. Introduced and developed by Kaplan and Norton (2002, 2005) for the business sector, its central premises are that a company should be evaluated on its progress towards its strategic objectives using both traditional financial measures and measures in three other areas: customer perspective, internal business processes and organizational learning and growth. Indicators should measure organization performance for key strategic objectives in all four areas and should be composed of component parts that reflect specific company practices. (Santiago , 2005, 76) The BSC thus provides both a comprehensive picture of a business's progress and a guide for targeting interventions.

A decision was made to add mental health and addictions inpatient care to the suite, pending a feasibility study. This paper describes the process and results of that study, focusing on three issues: assessment of framework relevance, strategic goal selection and indicator selection.

Study Background

The Hospital Report Research Collaborative (HRRC) was a partnership between academic centres, hospital stakeholders and the England Ministry of Health and Long-Term Care, formed in 1997 to develop relevant and scientifically valid report cards for monitoring the quality of inpatient care. (Rosenheck , DiLella , 2000) The HRRC (2007) focused first on acute care and expanded quickly to other health sectors. Its reports were based on the BSC framework for healthcare organizations proposed by Baker and Pink (2005), who re-conceptualized the four quadrants as clinical utilization and outcome, system integration and change (the equivalent to Kaplan and Norton's innovation and learning quadrant), patient satisfaction and financial performance and condition.

A study was funded to develop a mental health hospital report following these three steps. The team formed a multi-stakeholder advisory panel to provide consultation and advice throughout the study. (Rosenheck , Cicchetti , 2004, 85) Additionally, the team attended HRRC meetings to maintain as much consistency as possible with the definitions and methods used in the other sectors. In developing its report, the study team encountered three significant problems that required resolution. The first was that the four quadrants described by ...