June 20, 2016

Balanced Score Card

Dr. Yaser Abdelhadi (BSEE, MS CS

PhD CS, PhD BM)

EJABI is Jordans premier management development institute, provider of excellent management learning opportunities for managers at all levels. Initiated by EJADA and ACI

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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.
June 20, 2016

Balanced Score Card

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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
June 20, 2016

Balanced Score Card

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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

June 20, 2016

Balanced Score Card

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Strategy Development

June 20, 2016

Balanced Score Card

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Ive always reckoned that a camel is a horse designed by a committee

- Freddie Laker
Balanced Score Card
June 20, 2016
6

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Quality Gurus

1996
Deming

Ronald
Fisher

1910

BALANCED
SCORECARD

Morgensen
Feigenbaum

Shewart

1920

1930

G.S. Radford

June 20, 2016

1940

1950

1960

Akao Crosby

1970

1980

Mizuno Tribus
Taguchi

Sarasohn
Juran

Kano

1990

2000

David Norton
Robert Kaplan

2001 STRATEGY-FOCUSED
7
ORGANIZATION

Ishikawa
Balanced
Score Card

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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
June 20, 2016

Balanced Score Card

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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 organizations strategy.
invest in the long term rather than
manage the bottom line to pump up shortterm gains.
June 20, 2016

Balanced Score Card

Success !

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Ultimate Goal, to Become a:

STRATEGY-FOCUSED ORGANIZATION
1

June 20, 2016

Balanced Score Card

10

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BalancedScorecardProvidestheBridgefromStrategy
toOperations
VISION
Why we exist
VALUES
Whats important to us

MISSION
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
SHAREHOLDERS

Delighted
CUSTOMERS

Efficient and Effective

PROCESSES

Motivated & Prepared

WORKFORCE

Financial

Customers

Internal Process

Learning & Growth

June 20, 2016

Balanced Score Card

11

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A FRAMEWORK TO TRANSLATE STRATEGY INTO OPERATIONAL TERMS

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

CUSTOMER:
To achieve our vision,
how should we appear
to our customers?

VISION
MISSION
STRATEGY

INTERNAL
BUSINESS
PROCESSES:
To satisfy our
shareholders and
customers, what
business processes
must we excel at?

LEARNING AND
GROWTH:

June 20, 2016

To achieve our vision

how will we sustain
our ability to
Balanced Score Card
change and improve?

12

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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
A measurement system designed to influence behavior should describe the strategy

Strategy

A good Balanced Scorecard describes the organization strategy

June 20, 2016

Balanced
Scorecard

Balanced Score Card

13

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The Performance Management Cycle

Business
BusinessPlans:
Plans:
Balanced
Balancedscore
scorecard
card
Core
Corecompetences
competences
Individual
Individualrole:
role:
Accountabilities
Accountabilities
Competence
Competence

Plan

Performance
Performance
Planning
Planning

Evaluation

June 20, 2016

Coaching

Performance
Performance
Measurement
Measurement

Performance
Performance
Development
Development

Balanced Score Card

Action

14
Feedback

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Integrate your SWOT and Your Long Range Strategic Plan

Into Your Strategy Map
STRENGTHS
Quality of Care (3)
Command Communication-External
Lack of Local Healthcare Competition
Reputation
CUSTOMER & Facilities/Infrastructure
STAKEHOLDER

Technology and Equipment

JCAHO (1)
Access to Data Sources
ADP Technology Skills
INTERNAL MTF Staff Versus MCSC Staff Relationships
PROCESS Clinical Practice Guidelines (1)

Internal Clinical Training/Certification

Leadership
Dedicated and Stable Workforce
PA Education (clinical training)
LEARNING &
GROWTH

Satisfactory Budget
Known Budget

WEAKNESSES
Poor Access to own PCM
Rural Location
Culture for 'Free' Care (1)
Facility Layout (4)
Poorly Defined Customer Needs (2)
Poorly Defined Customer Wants

OPPORTUNITIES
THREATS
Base Realignment and Closure (1)
Payment for Patient Travel
Lose Customer to Alternative Healthcare
Fixed Customer Base
Outreach Programs
Aggressive Other Healthcare Systems
Real Estate
TRICARE for life
Population Health (5)
Telemedicine
Strengthen Relationship w/ Lead Agent & Post (1)
Strengthen relationship with Installation

Communication (1)
Metric Refinement & Development for Export
Data Collection and Analysis (2)
Template Management
Business Case Analysis (3)
Process Management (1)
Specialty Referral
Staffing Unresponsive to Short Term Demand (1)
Non Interfaced IT
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
Staff Satisfaction (2)
Export Training Programs
Low Volume Competency
Job Share/Exhange with Other MTFs
Orientation of New Providers
Basic Training Increase
Promotion Opportunities (1)
Educational Opportunity for Staff
Insufficient SW/ADP Training
Insufficient SW/ADP Staff (1)
Poor Job Performance Feedback
Skill Sustainment (3)

TMA Lead Agent (1)

Externally Imposed Metrics (2)

Fixed Funding but Increasing Costs

Distribution of End of Year Funds

Unstable Budget

MCSC Nurse Triage System

Long
LONG
Range
RANGE
Strategic
STRATEGIC
Plan
PLAN

Isolation Nursing Shortage (1)

Limited and Expensive Labor Pool
CPO Rules (1)

FINANCIAL

Theme 1Theme 2Theme 3Theme 4

Internal Customer Financial

Vision:TheIntegratedandResponsiveSystemofChoiceForQualityHealthServicesin
ServiceoftheArmyatHomeandAbroad
19 JAN 01
DoD/Army/Soldiers

Mission
Internal/Process

SWOT analysis presents an opportunity to

express Strengths, Weaknesses, Opportunities,
and Threats in the context of the Balanced
Scorecard

Customer / Stakeholder

L&G

Project and Sustain A Healthy and Medically Protected Force

Trained
AMEDD

Flexible
Medical Forces

Smaller
Footprint

Return
Soldiers to
Duty

DoD/Army

Manage and Promote the Health of the Soldier Family and the Military Family
Timely, Friendly,
Compassionate Competent
Care

Improve the Health

of the Population

Deploy solutions for

AMEDD to support
Army
Transformation

Provide State of the Art

Health Risk Assessments
and Countermeasures
Fast, complete, and effective
monitoring and reporting of medical
threats and the forces health and
fitness
Efficient, effective development,
application and evaluation of health and
fitness standards

Leverage capabilities of
institutional AMEDD

Satisfy Patients
and Their
Families

Reduce Cost of
Ownership of the
Deployable Force

Beneficiary/DoD/Army
Maxim ize Total (MCSC+
Direct) System Efficiency

Continually
Improve
Operations

Manage the Care of Our

Beneficiaries

Better alignment of resources with population requirements

Better, safer patient care processes
Simpler, more streamlined access to care
Better integration with network providers systems of care
Best training programs for our caregivers
Compassionate disposition of the medically unfit soldier

Improve Marketing of
Army Healthcare
System
Reduce variation in
clinical and business
practices across the
AMEDD
Fast, accurate
analysis, forecasting,
modeling and planning

Enable Mission Readiness

Financial

Balanced Score Card

Lower Armys
Medically Related
Costs

Deploy a Trained and Equipped Medical Force That Supports Army Transformation

Recruit
& Retain a Quality
AMEDD Force

June 20, 2016

Protected From
Disease and
Injury

Healthy
Soldiers

Leverage Information
Management and
Information Technology

Leverage all Sources of Medical

and Non-Medical Technologies to
Generate High Value Solutions

Achieve Fiscal Accountability

Predict and Secure
Levels of Funding
Required

Operate Within
Budget

Build and Maintain

Reliable Facility and
Installation
Infrastructure

15

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AMEDD Strategic Goal #3:

Manage the Care of the Soldier

and the Military Family
Strategic Theme:
Focus on our Customers

DevelopingtheAMEDD
BSC

Strategic Objectives:

Customer

Quality,
Compassionate
Care

Eliminate the
Hassle Factor

Strategic Objective

Internal
Process
Safe
Patient Care

Streamline
Access to Care

Streamline
Access to Care

Measure
% appointments
meeting TRICARE
access standards

Target
82%

Initiative
Increase # of
MTFs with web
access to
appointments

Learning
& Growth
Train the Medical
Force

Recruit & Retain a

Quality Medical
Force

Financial
Operate within Budget
Predict & Secure Levels
of Funding Required

June 20, 2016

Strategic
Objectives:
What the
strategy is
trying to
achieve.

Measures:
How success
or failure
(performance)
against
objectives is
monitored.

Balanced Score Card

Initiatives:
Targets:
The stated Breakthrough
action
level of
programs
performance
initiated to
or rate of
achieve
improvement
targets
desired

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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

June 20, 2016

Balanced Score Card

17

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SWOT

June 20, 2016

Balanced Score Card

18

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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?
Balanced Score Card
June 20,
2016
19

June 20, 2016

Weaknesses Opportunities

Threats

Customer

Financial

Strengths

Internal

What are my financial strengths,

weaknesses, opportunities and
threats?
From the customers perspective,
what are my strengths,
weaknesses, opportunities and
threats?
Internally, consider your
processes; what are the strengths,
weaknesses, opportunities and
threats?
From my employees perspective
regarding culture, technical
infrastructure and competencies/
skills, what are my strengths,
weaknesses, opportunities and
threats?

L&G

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1. Think of the SWOT Issues in Terms of the BSC Perspectives

Balanced Score Card

20

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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
major20,
employment
and finance
tax base
forCard
this rural community.
Balanced
Score
June
2016

21

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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.
June 20, 2016

Balanced Score Card

22

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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. Its 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.
June 20, 2016

Balanced Score Card

23

STRENGTHS

WEAKNESSES

OPPORTUNITIES

THREATS

LEARNING &
GROWTH

CUSTOMER

FINANCIAL/
RESOURCES

BSC Perspectives

INTERNAL
PROCESSES

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SWOT:

June 20, 2016

Balanced Score Card

24

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.

Weaknesses Opportunities

Threats

Theme 1

Theme 2

Theme 3

Theme 4

Internal

Customer

Financial

Strengths

L&G

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1. SWOT + Scorecard = SWOT CARD

June 20, 2016

Balanced Score Card

25

F in a n c ia l C u s t o m e r /S t a k e h o ld e r

Strategy Maps and Scorecards

AMEDD
Strategy

Vision:TheIntegratedandResponsiveSystemofChoiceForQualityHealthServicesin
Version: 1 DEC
ServiceoftheArmyatHomeandAbroad
Project and Sustain a Healthy
and Med ically Protected Force

Deploy a Trained and Equipped

Medical Force

Provide a force that is

healthy, fit and protected
from injury and disease
C1

Manage and Promote the Health

of the Soldier Family and the Military Family
Provide improved
access to high
quali ty health care
at the lowest
possibl e cost C5

Deploy a trai ned and

equipped medical force that
supports Army
transformation C3

Achieving Fiscal Accoun tability

Demonstrate true
ROI for
shareholders I4

Accuratel y predict and secure levels

of funding required F 1

Operate within budget F3

Reduce the
Armys medicall y
related costs F5

Obje
ctive
s

Initia
tives

Goal
s

Mea
sure
s

Do predictive
mo deling of health
readiness and
threats I5

Align
incentives to
support
preventio n L2

Align resources with

changi ng mission
and population I9

Leverage
capabilities of the
institutional
AMEDD to support
operational
medicine I7

Support the
dev elopment and
implementation of
health and fitness
standards I 14

Improve
beneficiary
rel ations hip
management
I11

Improve quali ty
of care I10

Design, man, train,

equip, and sustain
fully capable
medical systems I6

Increase access
I8

Improve at managed
care contract
negotiation and
m anagement I13

Continuou sly Improve Operations an d Processes

Develop the capabil ity for
fast, accurate analysis,
forecasting, modeling and
planning I15

Identify and
implement best
practices L5

Improve marketi ng of
c Army Healthcare
the
System I16

Enable Mission Readiness

MSC
Strategic
Plans

F i n a n c ia l C u s t o m e r /S t a k e h o ld e r

Lev erage AMEDD

science to engage
the DoD/Arm y in
shaping policy I2

Optimize facili ty
and installation
infras tructure L7

Leverage information
man agem ent and
info rm ation technology
L4

Recruit, train and

retain a quality medical
force L6

Vision:TheIntegratedandResponsiveSystemofChoiceForQualityHealthServicesin
Version: 1 DEC
ServiceoftheArmyatHomeandAbroad
Project and Sustain a Health y
and Medically Protected Fo rce

Deploy a Trained and Equipped

Medical Force

Provide a force that is

healthy, fit and protected
from injury and disease
C1

Manage and Promote the Health

of the Soldier Family and the Military Family
Provide improved
acces s to high
quality health care
at the lowest
possible cost C5

Deploy a trained and

equipped medical force that
supports Army
transformation C3

Achieving Fiscal Accountability

Demon strate true

ROI for
shareholders I4

Accurately predict and secure level s

of fundi ng required F1

O perate withi n budget F3

Reduce the
Armys medicall y
related costs F5

Obje
ctive
s

Mea
sure
s

Goal
s

Initia
tives

Maximize total (MCSC+

Direct) system efficiency F7

Improve
monitoring and
reporting on
medical thre ats
a nd the forces
health fitness L1

Develop and provide

state of the art risk
countermea sures I 1

Align
incentives to
support
prevention L2

Align resources with

changing mission
and population I9

Leverage
capabilities of the
instituti onal
AMEDD to support
operational
medicine I7

Support the
dev elopment and
implemen tation of
health and fitness
standards I 14

Improve
beneficiary
rel ationship
management
I11

Improve qual ity

of care I10

Design, man, train,

equip, and sustain
fully capable
medical systems I6

Do predictive
mo deling of health
rea din ess and
threats I5

Increase access
I8

Improve at managed
care contract
negotiation and
management I13

Continuously Improve Operatio ns and Processes

Develop the capabil ity for
fast, accurate analysis,
forecasting, modeling and
planning I15

Identify and
implement best
practices L5

Improve marketing of
c Army Healthcare
the
System I16

Enable Mission Readiness

Lev erage AMEDD
science to engage
the Do D/Arm y in
shaping policy I2

F i n a n c ia l C u s t o m e r /S t a k e h o ld e r

Vision:TheIntegratedandResponsiveSystemofChoiceForQualityHealthServicesin
ServiceoftheArmyatHomeandAbroad
Version: 1 DEC
Project and Sustain a Healthy
and Medically Protected Force

Depl oy a trai ned and

equipped medical force that
supports Army
transformation C3

Accurately predict and secure levels

of funding required F1

Improve
monitoring and
reporting on
medic al threats
and the forces
health fitness L1

Demonstrate true
ROI for
shareholders I4

Develop and provide

state o f the art risk
counte rm easures I 1
Do predictive
modeling of health
readiness and
threats I5

Align
incentives to
support
prev ention L2

Support the
dev elopment and
implementation of
health and fitness
standards I 14

Reduce the
Armys medically
related costs F5

Manag e and Promote the Health

of the Soldier Family and the Military Fa mily
Provi de improved
access to high
quali ty health care
at the lowest
possible cost C5

Operate within budget F3

Obje
ctive
s

Mea
sure
s

Goal
s

Initia
tives

Desi gn, man, train,

equip, and sustain
full y capable
medi cal systems I6
Leverage
capabilities of the
i nstitutional
AMEDD to support
operational
medi cine I7

Im prove
beneficiary
relationship
management
I11

Improve quality
of care I10

Align resources with

changi ng mission
and population I9

Increase access
I8

Improve at managed
care contract
negotiation and
management I13

Continuously Improve Operations and Processes

Develop the capability for
fast, accurate analysis,
forecasting, model ing and
planning I15

Identi fy and
implement bes t
practices L5

Improve marketing of
c Army Heal thcare
the
System I16

Enable Mission Readin ess

Lev erage AMEDD
science to engage
the DoD/Army in
shaping policy I2

Functional,
Team,
Individual
Plans

Deploy a Trained and Equipp ed

Medical Force

Provide a force that i s

healthy, fit and protected
from injury and disease
C1

Achieving Fiscal Accountability

Maximiz e total (MCSC+

Direct) system efficiency F7

In te r n a l /P r o c e s s

Unit
Strategic
Plans

Optimize facility
and installation
infrastructure L7

Leverage information
management and
information technology
L4

Recruit, train and

retain a quality medical
force L6

Recruit, train and

retain a quality medical
force L6

Objecti
ves

Measur
es

Leverage information
ma nagement and
information technology
L4

Goals

Optimi ze facil ity

and installati on
infrastructure L7

Initiativ
es

Balancedand
ScoreAllocate
Card
June 20, 2016 Communicate

Measure and Manage

In t e r n a l/P r o c e s s

Maximize total (MCSC+

Direct) system efficiency F7
Dev elop and provide
state of th e art risk
countermea sures I 1

Improve
monitoring and
reporting on
medica l th reats
and th e forces
health fitness L1

In te r n a l /P r o c e s s

Formulate and Align

Develop With Us

Learn and Improve

Aligned functional,
team, and individual
performance
objectives,
measures, goals,
and action plans

26

Develop With Us

How Do You Measure Strategy?

Strategy

To be
successful, what
customer/stakeholder needs
must we serve?

Customer/
Stakeholder

Customer Perspective
Objectives Measures Targets
Initiatives
Image
Service
Price/Cost

Internal/Process

To satisfy our
customers/
stakeholders, in
which internal
business
processes must
we excel?"

Learning and
Growth
June 20, 2016

The Balanced Scorecard converts

strategy into an integrated system
of objectives, measures, targets,
and initiatives defined across four
organizational perspectives

Objectives

Internal Perspective
Measures Targets

Initiatives

Cycle
Time
Quality
Productivity

" To achieve
our process
goals, how
must our
organization
learn and
innovate?

Objectives
Market
Innovation

Learning Perspective
Measures Targets

Initiatives

Continuous
Learning
Intellectual
Assets

"To meet our

organizational
goals, what
resources will we
need and which
constraints must
we consider?

Objectives
Profitability

Financial Perspective
Measures Targets

Financial
Balanced Score Card
Growth
Shareholder
Value

Initiatives

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Balanced Scorecard

Measurement System Goals

1.
2.
3.
4.

June 20, 2016

Understand current state

Manage by fact
Encourage communication
Promote focus and alignment

Balanced Score Card

28

Develop With Us

XYZ Measures
Linkages

Actual monthly expenses as a

% of budgeted expenses

Draft (8/7/99)
Financial
Customer
Process
Learning&Growth
Critical Perspective Measure

Actual project expenses as a

% of budgeted expenses
Customer satisfaction
rating

% of projects with defined

and managed project plans

Reporting process project status

% of project solutions
implemented within required
quality and performance levels

Earned value analysis Cost and schedule variances

Cost Model defined and

implemented

% of customers and suppliers

identified with defined
interdependencies

% of scope changes effecting

schedule and budget

% of required meetings
attended

NBI Process - % NBIs

with assigned and engaged
XYZ representative
Prioritization - # of projects
with established priority

Needs assessment gap required vs. actual skills

required
% XYZ employees
w/completed skills analysis

% identified XYZ positions w/

completed competency models

June 20, 2016

% XYZ training scheduled

& completed
% increase in XYZ skill
levels

Increase XYZ process

effectiveness &
efficiencies

XYZ employee
satisfaction

XYZ turnover rate

Balanced

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 XYZ employees with

access
to required tools
Score
Card

# of Post Implementation
Reviews conducted 29

Develop With Us

Balanced Scorecard
10.
9.
8.
7.
6.
5.
4.
3.
2.
1.

Measurement Systems Top Ten Problem List

Data Overload
Short-Term Focus
Lack of Detail
Measuring Whats Easy
Measuring What Doesnt Matter
Focus on Behavior not Process Results
Measures that Discourage Teamwork
Customer, What Customer?
Wrong Performance Drivers
Doing It Because Everyone Else Is !

June 20, 2016

Balanced Score Card

30

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Balanced Scorecard

MEASUREMENT LIFE CYCLE:

Select
Measure

Specify
Definitions

Plan for
Deployment

Validate
Data

Analyze

Report

June 20, 2016

Balanced Score Card

Collect
Data
Take
Appropriate
Action
Retire
Measure

31

Develop With Us

Integrated Strategic Management System

(SMS)
R&A

National
SecurityStrategy
NationalMilitary
Strategy
JointVision
2020
TheArmyPlan
Army
Transformation
Strategy

Balanced
Scorecard

Vision
Goals

Optimization

-Objectives
-Measures

Strategy

MHS
StrategicPlan

Business
Case
Analysis

3-5yrs

-Targets
-Initiatives

AMEDD
MSC

AMEDD

0-1.5yrs

Subordinate

Business
Plans
MSC
Subordinate

TSG
Vision
Mission
Values

June 20, 2016

Budget

Balanced Score Card

POM

32

Develop With Us

AMEDD
BALANCED
SCORECARD
June 20, 2016

Balanced Score Card

33

DoD/Army/Soldiers
Financial

Protected From
Disease and Injury

Healthy Soldiers

Lower Armys Medically

Related Costs

Deploy a Trained and Equipped Medical Force That Supports Army Transformation
Flexible Medical
Forces

Trained Medics

DoD/Army
Financial

Smaller Footprint

Reduce Cost of
Ownership of the
Deployable Force

Manage the Care of the Soldier and the Military Family

Quality,
Compassionate
Care

Passion for
Eliminating
Wasted Time

Healthy Patients
and Families Are
#1

Beneficiary/DoD/Army

Eliminate the
Hassle Factor

Financial

Develop With Us

Mission Customer /
Stakeholder

Project and Sustain A Healthy and Medically Protected Force

Maximize Total
(MCSC+ Direct)
System Efficiency

Financial

Learning
& Growth

Internal

Internal/
Process

Focus on Our Customers

Provide State of
the Art Health Risk
Assessments and
Countermeasures
Monitor Medical
Threats and the
Fitness of the Force

Leverage Science and

Technology

Expedient,
Compassionate
Disposition of Medically
Unfit Soldiers

Products to Market to
Support Army
Transformation

Leverage
Capabilities of
Institutional AMEDD

Return Soldiers to
Duty

Implement Clinical
and Business Best
Practices

Streamline Access
to Care

Develop, Fast
Accurate Analysis,
Forecasting, Modeling
and Planning

Maintain a
Reliable Facility
and Installation
Infrastructure

Integrate Direct and

Network Care

Safe Patient Care

Align Resources
With Population
Requirements

Market the Army

Healthcare System

Enable Mission Readiness

Recruit
& Retain a Quality
AMEDD Force

Develop Leaders

Train the Medical Force

Leverage Information
Management and Information
Technology

Achieve Fiscal Responsibility

June 20, 2016

Balanced Score Card

Predict and Secure

Levels of Funding
Required

Operate Within Budget

34

Develop With Us

North Atlantic Regional Medical Command

Serving the Area of our Colonial Beginnings and the Nations
Capitol with Pride, Competence, and Character

Vision Statement

Americas leading Regional health system focused on readiness and academic excellence
while providing well-coordinated care for the worlds 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
Balanced Score Card
June 20, 2016

35

Develop With Us
June 20, 2016

Balanced Score Card

36

Develop With Us

NARMC
PRIORITY

Supporting
Theme: Excellence in Resource Stewardship
Predict and Secure
Levels of Resources
Required F5

Financial

Strategic Theme:

Operate within
Budget F6

#18

Objective Statement

Measures

F-5 Predict and secure

levels of resources
required by producing
timely, accurate, and
prospective business case
analyses, Budget Estimate,
POM, and Mid-year Review
submissions.

Target FY 01

#18

F-6 Ensure all MTFs

operate within a budget
commensurate with mission
and buying power.

June 20, 2016

Balanced Score Card

37

Building Trust & Earning Respect

Mission/ Customer /
Stakeholder

Develop With Us

REGIONALProject
COMMAND
AND CONTROL DEPLOY A HEALTHY FORCE DEPLOY A MEDICAL FORCE PROVIDE & MANAGE HEALTHCARE
CARING FOR SOLDIERS & STAFF
and Sustain A Healthy and Medically Protected Force
DoD/Army/Soldiers

Internal/Process
Learning
& Growth

Trained
PROFIS
Soldiers C4

Passion for
Eliminating
Wasted Time
C9

Eliminate the
Hassle Factor
C8

Healthy Patients
and Families are #1
C5

Quality
Compassionate
Service C6
Improve Facilities
Infrastructure IP14

Meet Line Cdrs

Expectations
C7

Leverage Information
Management/Information
Technology IP16

Assist Commanders
to Recruit, & Retain
a Quality Force L1

June 20, 2016

Ensure Quality
Patient Care IP4

Improve MTF
Business
Process IP11

Improve
Equipment
Acquisition IP15

Facilitate MTF
Accreditations
IP9

Facilitate Marketing
of Army Healthcare
System IP6

Integrate Direct and

Network Care IP12

Identify and
Implement Best
Practices IP17
Improve
WRAMC
Garrison
Operations
IP21

Manage the
91W Transition
IP2
Ensure a Trained
Workforce L2

Operate within
Budget F6

Plan & Implement

a Medical Force
Protection
Program IP7

Improve Access
IP5

Expedite Medical
Disposition of the
Soldier IP3

Leverage NARMC
Capabilities to Support
Institutional AMEDD
IP13

Optimize Total (MCSC+

Direct) System Efficiency
F3

Lower Armys
Medically Related
Costs F1

Ready Active and

Reserve Units C3
Healthy
Soldiers C1

Monitor, Analyze
and Interpret
Regional PM Data
IP1

Manage Data Quality

Program IP10

Financial

Protected from
Disease and
Injury C2

Clear Direction
and Priorities C10

Ensure Quality
Education &
Training
Improve Training
Programs IP19
and Readiness
Innovative Management IP8 Demonstrate Caring &
Respect For Soldiers &
Solutions C11
Civilian Workforce L4

Develop Leaders
L3

Align Resources with

Changing Mission and
Population IP18

Predict and Secure

Resources to
Balanced
Score Card
Levels of Resources
Support Missions
Required F5

F4

Reduce Cost of
Ownership of the
Deployable Force F2

38

Develop With Us
June 20, 2016

Balanced Score Card

39

Develop With Us

Building Trust, Earning Respect

North Atlantic Regional Medical Command
Balanced Scorecard Initiatives FY 2002
ACoS Objective Champion: (Legend):
Operations

Logistics

Personnel

Clinical

Resource Management

Garrison

Information Management/Information Technology

1. Review and update Mobilization Support

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

June 20, 2016

7. Develop Comprehensive Clinical Business

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

Balanced Score Card

Fully Implement Balanced Scorecard in NARMC

40

Develop With Us

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

June 20, 2016

Balanced Score Card

41

Develop With Us

SPEED
YAW
ALTITUDE

PITCH
DIRECTION

June 20, 2016

Balanced Score Card

42

Develop With Us

Three Financial Themes:

Revenue Growth and Mix

Cost Reduction / Productivity Improvement
Asset Utilization / Investment Strategy

June 20, 2016

Balanced Score Card

43

Develop With Us

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

June 20, 2016

Balanced Score Card

44

Develop With Us

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
organizations objectives
June 20, 2016

Balanced Score Card

45

Develop With Us

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
June 20, 2016

Balanced Score Card

46

Develop With Us

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 complicated for organization to
absorb
June 20, 2016

Balanced Score Card

47

Develop With Us

FINANCIAL

Return on Capital Employed

Customer Loyalty
CUSTOMER
On-Time Delivery
INTERNAL
LEARNING
& GROWTH
June 20, 2016

Process Quality

Process Cycle Time

Employee Skills

Balanced Score Card

48

Develop With Us

Cause and Effect Linkages Example

Financial

Improve Returns

ROI
Revenue Mix

Broaden Revenue Mix

Growth

Customer
Satisfaction
Retention
Relationships

Customer Satisfaction
Increase Customer Confidence

Process
Dev Cycle
Hrs w/Cust

Understand Customer
Segments

Develop the
Offering

New Prod Rev

L & G
Rev/employee

Employee Satisfaction

Job Coverage

Balanced Score Card

June 20, Improve
2016 Customer Information
Broaden Skills

Goals Aligned

Reward Alignment

49

Develop With Us

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
June 20, 2016

Balanced Score Card

50

Develop With Us

Lead Indicators: Focus management Attention on the

Drivers of Performance
e.g. Claims Quality Audit
Plan

Staff Development

Lag Indicators: Core Outcome Measures

e.g. Claims Frequency
Claims Severity
Loss Ratio
June 20, 2016

Balanced Score Card

Staff Productivity

51

Develop With Us

Linking Perspectives

To succeed
financially, how
should we
appear to our
stakeholders?

Financial
Profitability
Growth
Shareholder
Value

Cash Flow
Profits
Sales Growth
ROI, ROE
& ROA

Customer
Response

To satisfy our
customers, what
business
processes must
we excel at?

Processes

Cycle Time
Accuracy

Service

On Time

Quality

Error Rates

To achieve our
vision, how
should we
appear to our
June 20, 2016
customers?
Source: Professor. Kaplan and David P. Norton

Cycle Time
Quality
Retention

Organization
Innovation
Cont. Improve
Intellectual

New Prod/
Sales
Time Reduction

Mkt Value
Balanced
Score
Card
Assets

Turn Around
Time to Mkt
Error Rates
Turnover

To achieve our
vision, how will
we sustain our
ability to change
& improve? 52

Develop With Us

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
June 20, 2016

Balanced Score Card

53

Develop With Us

MEASUREMENT SYSTEM
TEMPLATES

June 20, 2016

Balanced Score Card

54

Develop With Us
June 20, 2016

Balanced Score Card

55

Develop With Us

Scorecard Health Check

Balance of Measures
Aligned to Strategic Objectives
Clear Linkages Between Measures
Measures are Non-Conflicting
Capability to Drive Change
June 20, 2016

Balanced Score Card

56

Develop With Us

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
Balanced Score Card

June 20, 2016

57