Scorecards & Dashboards: If you can measure it, you can manage it The 15 th Annual Region IX Management Training Conference FireSky Resort and Spa Scottsdale, Arizona 85251 Greg Brandenburg Chief Executive Officer
Columbia Basin Health Association 14 th Ave Medical Center Othello Family Clinic Wahluke Family Clinic Connell Family Dental Clinic
Who We Are Founded in 1973, CBHA s mission and purpose is to provide equal access to quality health care to all persons regardless of age, sex, color, ethnicity, national origin, or the ability to pay. CBHA won the first ever HIMSS Davies Community Health Award of Excellence. 2008 was the fourth time CBHA has placed in the top five Not-for-Profit Companies to Work For. CBHA has been accredited by the Joint Commission since 2002. In 2007, CBHA won the William O. Robertson Patient Safety Award for the Medication Reconciliation & Consultation Program
Course Objectives! Understand How You Can Develop and Implement a Scorecard/Dashboard System to Improve Your Organization Performance! Identify Performance Measures to Track! Identify Sources of Data for Reporting! Identify Benchmarks
What Are Scorecards & Dashboards?! A Set of Documents That Use Technologies and Processes That Gather Data to Understand and Analyze Business Performance.! If You Want To Develop a Scorecard/Dashboard System, a Quick & Painless Journey Cannot Be Promised.
Steps To Implementation! Software Applications! Technology! Mine The Data! Develop Processes! Metrics! Incentives! Culture! Sponsorship
Why Use Scorecards/Dashboards?! Organizations That Want To Be Competitive Must Have Some Attribute At Which They Are Better Than Their Competition! As A Tool To Measure Organizational Performance! As A Tool To Communicate And Provide Feedback To All Stakeholders! As A Strategic Management Tool To Outline Measures Important To Your Leadership Team! As A Goal-Setting Tool
What Should We Measure?! Things that are important to: " Board: How can we maximize the value and effectiveness of our mission? " Leadership & Supervisor Teams: How can we improve our processes to deliver our services better, faster, and more cost effective? " Employees: How can we support our processes through improved knowledge, skills, and technology? " Patients: How well do our products and services meet the needs of our patients?
What Should We Measure?! Look For Common, Repeating Program Elements " Overtime (%) " FTEs " Attendance (CBHA exception points ) " Cycle Times " Patient Complaints " Encounters
How Should We Measure?! Organization Wide " Billable Patient Visits " Patient Payor Source " Patient Wait and Cycle Times " Complaints by Department " Managed Care Enrollment by Program " Average Days in A/R " FTE s Compared to Budget " Overtime as % of Worked Hours Compared to Budget
Encounters Organization Wide Billable Patient Visits '08 Budget > 11,500/Month 14,000 13,000 12,000 11,000 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 - Total M edical Dent al Vision M SS/M CM Other Prof essional
Patient Complaints Organization Wide Patient Complaints 22 20 18 16 14 12 10 8 6 4 2 - < 9 Complaints Other Lab EyeCare Nursing Patient Services Administration Dental Medical Pharmacy
How Should We Measure?! Clinics Othello Family Clinic Wahluke Family Clinic 14 th Avenue Medical Center Othello Family Dental Clinic Wahluke Family Dental Clinic Connell Family Dental Clinic Othello EyeCare
Encounters Nursing Department Visits/FTE/Day '08 Budget > 10 visits 20 18 16 14 12 10 8 6 4 2 - Othello Mattaw a 14th Avenue
Encounters Othello Family Clinic Medical Visits/FTE/Day '08 Budget PS >17 / Nursing > 10 24 21 18 15 12 9 6 3 - Patient Service Nursing
How Should We Measure? Programs/Departments Billing WIC Call Center Patient Benefits Human Resources IT Support Services Case Management Lab Medical Providers Nursing Dental Providers Pharmacy Chronic Disease Mgmt
Encounters Medical Providers Encounters / Provider Hours '08 Budget = 3 6 5 4 3 2 1 0
UDS Grantee Comparison Report - Medical UNIVERSAL Averages National Percentiles Grantee Grantee WA National Rural Large 25th Median 75th Percentile CY 2005 U3.21 Family Practice Productivity 5,006 3,687 3,963 4,027 4,075 3,146 3,781 4,448 88% U3.23 Internal Medicine Productivity 3,474 3,205 3,881 4,045 3,941 3,109 3,790 4,483 37% U3.24 OB/GYN Productivity 6,174 3,808 3,636 3,727 3,649 2,617 3,720 4,595 93% U3.25 Pediatric Productivity 7,610 3,352 3,985 4,201 4,068 2,923 3,697 4,387 99% U3.26 Overall Physician Productivity (excl. spec. phys.) 5,208 3,608 3,928 4,045 4,015 3,160 3,726 4,292 94% U3.27 NP/PA/CNM Productivity 3,985 3,016 2,850 3,041 2,969 2,211 2,787 3,316 92% U3.272 PA Productivity 3,985 3,179 3,042 3,162 3,176 2,247 2,935 3,579 84% U3.28 Medical Team Productivity 5,907 4,213 4,312 4,482 4,403 3,657 4,255 4,808 96% CY 2006 U3.21 Family Practice Productivity 5,059 3,371 3,858 3,961 3,971 3,086 3,703 4,348 90% U3.24 OB/GYN Productivity 6,285 3,281 3,596 3,673 3,625 2,634 3,558 4,585 92% U3.25 Pediatric Productivity 7,844 3,310 3,935 4,129 4,025 2,963 3,669 4,455 100% U3.26 Overall Physician Productivity (excl. spec. phys.) 5,349 3,349 3,846 3,969 3,937 3,080 3,676 4,261 96% U3.27 NP/PA/CNM Productivity 4,233 2,929 2,879 3,076 3,001 2,262 2,810 3,356 95% U3.272 PA Productivity 4,233 3,135 3,072 3,232 3,189 2,305 2,923 3,668 90% U3.28 Medical Team Productivity 6,107 3,933 4,256 4,464 4,338 3,635 4,207 4,796 96% CY 2007 U3.21 Family Practice Productivity 5,220 3,574 3,830 3,881 3,943 2,979 3,682 4,289 91% U3.23 Internal Medicine Productivity 1,932 2,818 3,755 3,944 3,850 2,843 3,605 4,287 6% U3.24 OB/GYN Productivity 6,769 3,529 3,616 3,776 3,642 2,566 3,429 4,546 93% U3.25 Pediatric Productivity 7,230 3,356 3,937 4,206 4,019 2,927 3,678 4,363 99% U3.26 Overall Physician Productivity (excl. spec. phys.) 5,300 3,467 3,826 3,953 3,921 3,039 3,638 4,208 94% U3.27 NP/PA/CNM Productivity 4,513 3,030 2,868 3,071 2,998 2,223 2,775 3,380 97% U3.272 PA Productivity 4,513 3,244 3,062 3,198 3,224 2,190 2,860 3,646 95% U3.28 Medical Team Productivity 6,161 4,072 4,248 4,463 4,336 3,568 4,205 4,737 96%
UDS Grantee Comparison Report - Dental UNIVERSAL Averages National Percentiles Grantee Grantee WA National Rural Large 25th Median 75th Percentile CY 2005 U3.31 Dentist Productivity 4,438 2,893 2,720 2,773 2,805 2,005 2,467 3,088 97% U3.32 Dental Hygenist Productivity 2,378 1,000 1,298 1,239 1,332 861 1,291 1,623 95% U3.33 Dental Team Productivity 4,486 2,803 2,700 2,722 2,784 2,035 2,463 3,066 97% CY 2006 U3.31 Dentist Productivity 4,526 2,945 2,702 2,764 2,781 1,996 2,525 3,089 97% U3.32 Dental Hygenist Productivity 2,692 1,006 1,379 1,282 1,420 904 1,338 1,731 96% U3.33 Dental Team Productivity 4,648 2,841 2,711 2,729 2,789 2,041 2,534 3,043 97% CY 2007 U3.31 Dentist Productivity 4,707 2,886 2,669 2,735 2,741 1,967 2,439 3,040 97% U3.32 Dental Hygenist Productivity 3,421 1,070 1,341 1,235 1,385 881 1,300 1,703 99% U3.33 Dental Team Productivity 5,008 2,812 2,671 2,686 2,746 1,987 2,491 2,995 98%
Encounters Billing Department Encounters/Billing FTE 1,800 1,600 1,400 1,200 1,000 800 600 400 200 - '08 Budget = 1200 Enc/FTE Target
Encounters Lab Department % Receiving Lab Services 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Othello Mattaw a 14th Ave
Encounters - Support Services Visits 2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 - Non-Billable Outreach In Clinic Behavioral Health
Computer Status - IT Computer Status 490 460 430 400 370 340 310 280 250 220 190 160 130 100 For Sale Pending Storage WIP Disposed Active
Encounters Patient Benefits < 3% 5.00% 4.00% % Self Pay Visits 3.00% 2.00% 1.00% 0.00% % Othello % Mattaw a %14th Avenue
All Providers - Dental All Providers-Dental Encounters No Charge Walk ins Center Cancels Wait times Provider time No Shows Charges Dec-07 2,323 15 165 39 17 38 174 $ 388,467 $ 162,145 8,093 12 20 1,626 $ 167.23 $ 69.80 3.48 188.4 Jan-08 2,597 12 186 74 17 38 189 $ 450,326 $ 210,592 9,399 13 22 1,420 173.40 81.09 3.62 194.8 Feb-08 2,548 17 193 81 18 38 154 $ 465,409 $ 175,669 9,563 15 21 1,582 182.66 68.94 3.75 172.7 Mar-08 2,505 7 220 88 18 40 114 $ 454,408 $ 190,180 9,295 15 21 1,705 181.40 75.92 3.71 171.3 2,611 13 193 135 15 38 131 $ 434,125 $ 195,275 8,605 14 22 1,738 166.27 74.79 3.30 189.9 2,488 13 192 148 13 38 135 $ 428,099 $ 184,334 8,558 14 21 1,724 172.07 74.09 3.44 176.1 2,598 14 195 122 13 36 140 $ 481,162 $ 162,120 9,344 14 21 1,707 185.20 62.40 3.60 185.6 2,623 7 216 124 14 38 106 $ 452,164 $ 208,236 8,905 14 22 1,680 172.38 79.39 3.40 185.7 2,733 14 179 146 13 37 121 $ 503,002 $ 195,134 9,810 15 21 1,725 184.05 71.40 3.59 185.3 2,531 6 144 108 13 37 175 $ 458,912 $ 164,029 8,508 14 21 1,783 181.32 64.81 3.36 180.8 Oct-08 - - - - - $ - $ - - - Nov-08 - - - - - $ - $ - - - YTD 25,557 118 1,883 1,065 15 38 1,439 4,516,074 1,847,714 90,080 140 212 $ 176.71 $ 72.30 3.52 182.8 Annualized 30,668 142 2,260 1,278 1,727 $ 5,419,289 $ 2,217,257 108,096 168 %'s 0% 7% 4% 5% 41% 66% 41% Receipts RVU's Days in clinic Clinic days PL Balance Charges per Encounter Receipts per Encounter RVU per Encounter Enc per days in clinic
All Providers - Medical All Providers-Medical Encounters No Charge Walk ins Center Cancels Wait times Provider time No Shows Charges Dec-07 6,906 52 652 186 17 46 371 $ 1,084,858 $ 494,242 8,537 17 20 4,799 $ 157.09 $ 71.57 1.24 397.6 Jan-08 8,123 66 681 206 14 43 362 $ 1,280,278 $ 531,150 10,343 20 22 4,896 157.61 65.39 1.27 403.1 Feb-08 8,254 69 797 191 16 44 406 $ 1,353,047 $ 504,529 10,412 19 21 5,167 163.93 61.13 1.26 428.8 Mar-08 8,463 72 880 199 15 43 395 $ 1,409,581 $ 594,193 10,964 20 21 5,388 166.56 70.21 1.30 430.7 8,777 65 820 207 16 45 441 $ 1,432,462 $ 599,094 11,028 20 22 5,531 163.21 68.26 1.26 434.5 8,062 62 765 224 15 43 407 $ 1,334,048 $ 562,643 10,141 19 21 5,812 165.47 69.79 1.26 427.7 7,921 77 854 183 15 43 443 $ 1,367,090 $ 604,434 10,473 18 21 5,703 172.59 76.31 1.32 436.4 8,526 83 876 229 15 42 460 $ 1,527,463 $ 565,624 11,457 20 22 5,457 179.15 66.34 1.34 431.7 8,187 60 933 216 15 45 512 $ 1,391,739 $ 552,502 10,337 18 21 4,994 169.99 67.49 1.26 447.0 8,604 87 1,226 178 14 43 555 $ 1,426,876 $ 620,499 10,691 19 21 5,118 165.84 72.12 1.24 447.9 Oct-08 - - - - - $ - $ - - - Nov-08 - - - - - $ - $ - - - YTD 81,823 693 8,484 2,019 15 44 4,352 13,607,442 5,628,910 104,382 191 212 $ 166.30 $ 68.79 1.28 428.6 Annualized 98,188 832 10,181 2,423 5,222 $ 16,328,931 $ 6,754,692 125,258 229 %'s 1% 10% 2% 5% 41% 90% 41% Receipts RVU's Days in clinic Clinic days PL Balance Charges per Encounter Receipts per Encounter RVU per Encounter Enc per Days in clinic
Data Particulars! Show Progress At A Glance " Running 6-months " 2 prior fiscal year averages " More Elements Than You Can Fit On A Graph? " Include data sheets for supervisors & leadership! Show targets where appropriate
Call Center Scorecard 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% OT < 5% Number of Abandoned Overtime Hours Equal or less than 3% Shift to Call Volume Overlay % Ovt Budget 12.00 11.00 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00-100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Full Time Equivalents '08 Budget = 11 Employee Utilization Logged in 85% of Worked Hrs Avg Calls/Day Non-Worked Worked % Logged % Phone 32 28 24 20 16 12 8 4 0 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Occurrences Per FTE/Yr < 12 per FTE/Yr Service Factor Greater than 90% in 30 Appointment Source Walk-in appointments are not included % TSF Goal 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% 7:00 AM 9:00 AM 11:00 AM 1:00 PM 3:00 PM 5:00 PM 7:00 PM Hours Worked Incoming Calls 2400 2000 1600 1200 800 400 0 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 All Depts Call Center
Call Center Detail Summary ~ 13 Month Trend ~ Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Clinic Days 21 21 19 23 20 20 22 21 21 22 21 21 22 21 21 Overtime Hours Regular 1,607 1,608 1,523 1,840 1,619 1,504 1,744 1,632 1,816 1,912 1,776 1,808 1,869 1,617 1,716 PL 161 140 156 186 127 164 207 300 193 152 63 145 166 251 163 Overtime 40 32 20 31 42 53 54 101 40 50 26 22 12 58 27 Total 1,808 1,780 1,699 2,058 1,788 1,722 2,005 2,034 2,049 2,114 1,865 1,975 2,047 1,926 1,907 % Ovt 2.21% 1.82% 1.18% 1.53% 2.34% 3.09% 2.70% 4.99% 1.94% 2.37% 1.38% 1.12% 0.59% 3.02% 1.44% Budget 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% Full Time Equivalents Worked 9.80 9.77 10.15 10.17 10.38 9.74 10.21 10.32 11.05 11.15 10.73 10.90 10.69 9.97 10.38 Non-Worked 0.96 0.83 1.03 1.01 0.79 1.03 1.18 1.79 1.15 0.86 0.38 0.86 0.94 1.49 0.97 Total FTE's 10.76 10.60 11.18 11.18 11.18 10.76 11.39 12.10 12.20 12.01 11.10 11.76 11.63 11.47 11.35 FTE Budget 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 Occurrences per FTE/Yr Occurrences 10 12 11 11 12 12 10 9 9 9 8 8 9 10 10 Number of Abandoned % Calls 2.08% 3.20% 3.75% 3.64% 5.34% 4.23% 2.47% 2.18% 2.57% 2.32% 1.98% 1.79% 2.47% 3.58% 2.59% Employee Utilization Worked 1,647 1,641 1,543 1,872 1,661 1,558 1,798 1,734 1,856 1,962 1,802 1,830 1,881 1,675 1,744 Logged in 1,407 1,392 1,345 1,576 1,395 1,372 1,614 1,543 1,627 1,669 1,523 1,612 1,616 1,439 1,475 % Logged 85.43% 84.86% 87.14% 84.21% 84.00% 88.07% 89.78% 88.99% 87.66% 85.09% 84.51% 88.11% 85.92% 85.88% 84.59% On Phone 597 694 664 817 777 698 777 761 738 723 621 750 750 773 748 % Phone 36.25% 42.32% 43.00% 43.65% 46.80% 44.79% 43.20% 43.88% 39.77% 36.87% 34.46% 40.97% 39.86% 46.14% 42.89% Total 3,652 3,728 3,551 4,266 3,834 3,628 4,189 4,038 4,221 4,355 3,946 4,192 4,247 3,886 3,967 Service Factor % TSF 91% 85% 84% 83% 76% 79% 86% 88% 84% 86% 87% 89% 86% 80% 85% Goal 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% Shift to Call Volume Totals Shift Time 1,606.95 1,571.03 1,506.13 1,782.48 1,624.21 1,542.92 1,543.92 1,688.63 1,767.44 1,776.83 1,731.31 1,808.04 1,817.13 1,610.30 1,687.09 Calls Offered 31,029 31,780 30,291 35,636 34,530 31,494 37,155 36,458 37,087 38,967 34,617 35,761 38,402 38,300 37,786 Average Calls per Day Calls Offered 1478 1513 1,594 1,549 1,727 1,575 1,689 1,736 1,766 1,771 1,648 1,703 1,746 1,824 1,799 Appointment Source All Depts 10,255 11,977 10,666 12,916 12,893 11,115 13,307 12,981 13,595 13,802 13,134 12,659 13,702 13,520 13,426 Call Center 6,577 6,778 5,918 6,924 7,519 6,169 7,222 8,106 8,324 7,940 6,906 6,690 8,446 8,503 8,098
Benchmark Sources! In-House Budget " Building Blocks of Budget! UDS Data " Nation and State-Wide Statistics " UDS Managerial Training! Surveys " Milliman " MGMA " NACHC
Getting the Job Done! Leadership Support & Commitment " Roll-Out Timeline! Dedicated & Knowledgeable Personnel! Accountability " Praise " Performance Improvement Committee " Performance Evaluation Goals Reliable Monthly Cycles " Due Dates! New Supervisor Training on Scorecards
Prominent Placement
The Ties that Bind: Nursing! Linking the Scorecard to the Incentive Plan! Patient Complaints! PHQ Screens! Attendance! Immunizations! Wait Times 32 28 24 20 16 12 8 4 0 Occurrences Per FTE/Yr < 12 per FTE/Yr 22 20 18 16 14 12 10 8 6 4 2-100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% Patient Complaints < 9 Complaints Immunization Compliance > 95% Other Lab EyeCare Nursing Patient Services Administration Dental Medical Pharmacy Othello Mattaw a 14th Avenue - 70 60 50 40 30 20 10 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Medical Cycle Times Wait Time < 15 Minutes PHQ Screening 85% PHQ-9 Screening Completed for Chronic Care 30.5% 34.2% Jan-08 Feb-08 59.5% Mar-08 67.0% 60.7% 87.1% 93.0% 94.3%93.5% Oct-08 Nov-08 Combined Provider Wait Dec-08
Useful Tools! Introduction to The Balanced Scorecard: Nine Steps To Success by the Balanced Scorecard Institute and the Strategy Management Group, Inc.
Useful Tools! Competing on Analytics by Thomas H. Davenport and Jeanne G. Harris
Questions?! Best wishes to your organization as you implement a Scorecard/Dashboard System of your own.! Visit us at: www.cbha.org