Internal Business Process Perspective Balanced Scorecard Turns

¶ … Internal Business Process Perspective balanced scorecard turns attention aspects organization's operations possibility direct control managers employees. The balanced scorecard at Duke's Children Hospital In the context of a rapidly evolving society, the health care sector must also develop new mechanisms by which to keep up with the emergent changes and challenges. One example in this sense is represented by the implementation of business tools and techniques within the act of health care provision.

One relevant example in this sense is offered by Duke Children's Hospital in Durham, North Carolina, which implemented the balanced scorecard to address some critical problems with costs of health care provision and nurse dissatisfaction. "Between 1993 and 1996 DCH's cost per case increased $4,389, while reimbursement declined, leading to a negative net margin in 1996 of $11 million dollars. During this same period, nurse productivity declined from 80th percentile to the 80th percentile, while patient and staff satisfaction declined to record lows" (Dunham-Taylor and Inczuk, 2006).

The balanced scorecard seemed the most adequate solution to addressing these problems and the method selected by the managerial team at the health care institution was represented by the integration of the business processes and the health care processes into a single unified effort (Meliones, Ballard, Liekweg and Burton, 2001). This approach was due to the belief that no process should take priority over the other (Dunham-Taylor and Pinczuk, 2006). 2.

Analysis The implementation of the balanced scorecard at the Duke Children's Hospital was based on the need to promote the business sustainability of the entity, without compromising the quality of the medical act. In their implementation of the balanced scorecard, distinctive emphasis came to be placed on three specific commitments, namely those of communicating, carting the path and never stopping.

At the level of communication, the managerial team focused on the communication of the problem that existed within the hospital; it listed to what the employees had to say; it improved the organizational culture and it changed the role of people. At the level of the path, the DCH's managers focused on a pilot project, developing and realistic goals, focus on information and the inclusion of the employees and their support in performance generation.

Finally, at the level of the continuance, emphasis came to be placed on mapping the business to the balanced scorecard and remaining consistent to this mapping; continually experimenting and learning from failures and encouraging strategic thinking at all of the organizational levels (Meliones, 2000). Aside from the actual balanced scorecard, the managers at the Duke Children's Hospital were also faced with the challenge of integrating the balanced scorecard within the overall context of the institution, in order to support the full attainment of the pre-established objectives.

In this order of ideas, the balanced scorecard was in charge of ensuring an organization wide strategic alignment, while it also interacted with leadership and improvement strategies. The leadership strategies were aimed to create support and structure and the improvement methods included the training of the staff members and the implementation of the Six Sigma, the DMAIC model -- where DMAIC stands for the stages of the process, namely definition, measurement, analysis, improvement and control (Meliones, Alton, Mericle, Ballard, Cesari, Frush and Mistry).

The reaction of the staff members to these challenges was a negative one initially, due to the fact that medical staffs have little interaction with and interest for the business efforts; in other words, it was initially difficult to integrate the staffs due to their reticence to changes determined by business objectives. Nevertheless, the managerial team was able to overcome this initial resistance to the implemented change by developing a training program and integrating all staffs within the training sessions (Meliones, Alton, Mericle, Ballard, Cesari, Frush and Mistry).

With the aid of these training programs, the staffs were introduced to the need for change, its benefits and gradually became engaged in the change process. 3. Conclusion and evaluation In the context of the changing and rapidly evolving health care sector, coupled with changes in society and technology, it is necessary for the health care providers to place more emphasis on complementary issues as well. In other words, they must also come to ensure their business stability, alongside with the provision of high quality medical acts.

In such a setting, Duke Children's Hospital decided to implement the balanced scorecard within its operations and the final results of the process were highly successful, generating increased financial stability, but also higher levels.