A positive image of the organization translates into repeat business and a more positive reputation in the neighborhood, Patient satisfaction translates into increased future revenues. It also has some positive impact on risk assessment as well. The more satisfied the customer is, the less likely they will file an adverse lawsuit against the hospital. Patient satisfaction has a direct impact on the profitability of the organization. The number of complains that the facility receives can also be an important measure of the overall customer satisfaction. However, this number alone may not tell the entire story. A customer survey is the best method for addressing overall satisfaction with the facility.

Patient involvement was another important indicator of BSC technologies. Patient involvement means providing numerous sources where treatment information can be found (Walker and Dunn 2006). It can also mean a conscious effort to make certain that the patient understands the procedures and the risks involved. The patient that is involved with their treatment process is more likely to report positive satisfaction than one that does not have such direct involvement.

Waiting time is another element of BSC that translates into increased customer satisfaction. Waiting time can be viewed from two different perspectives regarding performance measurement. First, the amount of time that a patient has to wait for a procedure or office visit reflects in overall patient satisfaction and revenues from repeat business. However, it can also be compared to inventory turnover in manufacturing. The amount of time from the patient's initial call to completion of the service or procedure can be reflected in turnover rates. Every patient on the waiting list reflects future receivables. Long wait lists may cause the patient to seek services elsewhere, resulting in lost revenues. The amount of time the patient has to wait may be reflected in terms of days between initial order and billable services rendered.

Internal processes include patient flow (discharge of patients and turnover of beds), accreditation, patient referral rates, patient retention, safety rates, and the establishment of additional services that can be offered in the future (Walker and Dunn 2006). In addition to these aspects, staff workload must be monitored so that employees do not become stressed, increasing the risk for serious mistakes. Maximizing staff goes beyond hiring more employees. It means monitoring the patient/staff ration and attempting to keep it low. Stressed, overworked employees create additional risk for the company through mistakes than an employee that is able to cope with the daily work environment. They are less likely engage in absenteeism and poor morale. Staff satisfaction surveys will be used to measure this aspect of the work environment. A grievance system will be set up so that staff can have an outlet for concerns.

Overall efficiency is reflected in the cost per patient, per treatment or procedure. Length of stay and staff costs can decrease efficiency by reducing the profit margin for each procedure (Walker and Dunn 2006). Overtime costs can also add into the equation. As one can see, reducing wait time and patient/staff ratios can have an impact on overall operational efficiency.

Another aspect of overall efficiency is facilities utilization. Downtime and the need to push back regular procedures for cases that are more acute decrease the efficiency of the organization (Walker and Dunn 2006). This is a key concern from an accounting perspective, but it is also one of the most difficult to control in a hospital setting. Allowances must be made to accommodate for these types of events.

Hospital access is an important factor in balanced scorecard analysis of the facility. There are many factors that may hinder the patient from utilizing the services of the hospital. Community access to the hospital may depend on outside agencies. Factors such as transportation, ethnicity, or financial matters may prevent persons from seeking the receiving the balanced medical treatment that they need. This translates into decreased revenue for the hospital. There may be outside organizations that can collaborate with the hospital that can help to alleviate these concerns.

The learning and growth perspective of the BSC approach to performance measurement is learning and growth performance. The position of the hospital should be such that it continually strives to make improvements and strive for higher levels of performance and patient satisfaction. This can be achieved through better equipment purchases, staff education, training and ongoing performance measurement.

Understanding how these items relate to performance measurement is the key to the development of metrics that will be used to definitively measure organizational progress. Individual goals and...

These individual benchmarks can then be related to overall organizational goals. The balanced scorecard method of performance measurement assesses many different elements and compares them in relation to the other factors addressed by the methodology.
Implementing Balanced Scorecard Performance Measurement

The first step to implementation of the BSC performance measurement methodology is to analyze the current state of affairs within each of the service areas of the hospital. This will involve a detailed analysis of the areas of operation, including the individual procedures themselves. This detailed analysis will give the hospital an overall picture of its current level of functioning in the various areas.

After the analysis of the various areas of performance has been completed, specific, quantifiable benchmarks will be set for each of the criteria. Benchmarks will be set for short-term, medium term and long-term goals in each of the applicable areas for every department. These goals will relate to overall goals and missions of the organization.

Implementation of BSC performance measurement methodology will involve ongoing analysis and assessment. It will involve the development of a tracking system for recording the various elements of the plan. Presentation of BSC results will become a part of regular hospital staff meetings and strategy planning meetings.

In order to be successful in improving patient outcomes and satisfaction with services, BSC will have to become an integral part of hospital culture. Everyone must be committed to improving quality and efficiency on all levels of the organization. Implementation of BSC requires both a micro approach in looking at the details of the organization and a macro approach that is able to look at organizational and community goals. The purpose of adopting BSC is to provide a detailed analysis and plan for implementing quality improvements in the organizational structure. The ultimate goal is a hospital that can better serve the community around it.

From a BSC standpoint, the only thing that separates a privately owned for profit hospital and a not-for-profit hospital is the level of profit set as a benchmark. Those that are for profit wish to retain a higher portion of earnings than those that are not-for-profit. However, both of these types of organizations have the same purpose in that they are committed to serving the health needs of the community around them. The for-profit not-for-profit hospitals have different methodologies for meeting the goals of BSC, but in many cases, they are the same.

There are many stakeholders that depend on the ability of the organization to produce quantifiable results for comparison over time. The community is the greatest stakeholder in the success of this project. They stand to gain an important asset that will continue to provide them payback well into the future. Other stakeholders, such as the Board of Directors and other administrative staff will also reap the benefits of increased profits, despite rising costs in the future.

In today's economic environment it is essential for organizations to gain a thorough understanding of the forces that drive their organization. Organizations cannot gain the tight controls needed to manage in the financial turmoil that plagues the healthcare industry. Unfortunately, the scenario is expected to get worse in the future. It is important to develop a roadmap that shows where the organization is now in terms of the focal points discussed. The organization needs to develop clear goals that can be measured in quantifiable benchmarks that will help pave the road for the future.

The adoption of Balanced Scorecard performance measurement will produce measurable results on all levels of the hospital. It will provide a means to measure progress against a certain set of standards. BSC will provide assurances that the hospital will continue to operate efficiently in the future, even as the need to be increasingly more efficient increases. Balanced scorecard method represents meaningful quantitative analysis of all of the hospitals assets and liabilities. Balanced scorecard is an excellent choice of methodology to apply to this hospital setting.