Abstract
BackgroundAll aspects of the heath care sector are being asked to account for their performance. This poses unique challenges for local public health units with their traditional focus on population health and their emphasis on disease prevention, health promotion and protection. Reliance on measures of health status provides an imprecise and partial picture of the performance of a health unit. In 2004 the provincial Institute for Clinical Evaluative Sciences based in Ontario, Canada introduced a public-health specific balanced scorecard framework. We present the conceptual deliberations and decisions undertaken by a health unit while adopting the framework.DiscussionPosing, pondering and answering key questions assisted in applying the framework and developing indicators. Questions such as: Who should be involved in developing performance indicators? What level of performance should be measured? Who is the primary intended audience? Where and how do we begin? What types of indicators should populate the health status and determinants quadrant? What types of indicators should populate the resources and services quadrant? What type of indicators should populate the community engagement quadrant? What types of indicators should populate the integration and responsiveness quadrants? Should we try to link the quadrants? What comparators do we use? How do we move from a baseline report card to a continuous quality improvement management tool?SummaryAn inclusive, participatory process was chosen for defining and creating indicators to populate the four quadrants. Examples of indicators that populate the four quadrants of the scorecard are presented and key decisions are highlighted that facilitated the process.
Highlights
All aspects of the heath care sector are being asked to account for their performance
The balanced scorecard (BSC) is a management tool, originally applied to businesses in the private sector, developed by Kaplan and Norton in 1992 [4]. Its creators describe it as "a multidimensional framework for describing, implementing and managing strategy at all levels of an enterprise by linking objectives, initiatives and measures to an organization's strategy" [4]. Their tool broadened the traditional notion held by private sector companies that performance is indicated by financial measures solely, by integrating financial measures with other key performance indicators linked to three additional areas: customer preferences, internal business processes and organization growth, learning and development
Who should be involved in developing the performance indicators? The BSC provides a framework for reporting about performance
Summary
Who should be involved in developing the performance indicators? The BSC provides a framework for reporting about performance. The health unit may not have developed strategic alliances with the police (community engagement quadrant) and there is emerging evidence that reducing the legal alcohol limit for driving and promoting designated drivers programs is associated with a lower motor vehicle collision rate (integration and responsiveness quadrant) Based on this assessment, a decision to enhance resources in this program area may be made together with the establishment of a partnership with the police department to advocate for a change in legislation. In general the staff experienced the development of the scorecard as an informative and valuable exercise, but questioned the utility and relevance of some of the indicators as aids in program specific decision making They recommended that a process be established to revisit and refine indicators and that more interpretation of indicators be provided in the text of the report. The program areas have been tasked with identifying variances from baseline and offering explanations, which will be provided in our second scorecard and presented to our governing Board
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