Healthcare Performance Scorecard for Diabetic Patients Over 65

Introduction and Scorecard Overview

Performance scorecards provide a straightforward means of integrating metrics into a healthcare organization's strategic planning. Scorecards are most effective when they have a clear purpose, identifying specific patient populations and outcome measures. According to Baker (2015), "savvy organizations select the best metrics to track that are appropriate to what the organizational staff members wish to measure," which could include specific issues like patient vital signs or patient satisfaction survey outcomes (p. 224). Moreover, performance scorecards need to be simple and kept on a manageable scale so that the data gleaned can be readily communicated to inform organizational practices, policies, and procedures (Hansel, n.d.).

The following performance scorecard includes four core categories — performance, quality, patient safety, and employee engagement — all while focusing on the needs of a specific patient population: adults over the age of 65 who have been diagnosed with Type II Diabetes.

Outcome Measures by Category

The outcome measures for performance include mortality rates within the patient population and readmission rates.

Performance outcomes for quality include the number of patients receiving at-home testing equipment for self-monitoring, the number of patients receiving lifestyle counseling and preventative care, complications related to Type II Diabetes, and patient perception of care.

Patient safety outcomes include the number of equipment and/or test failures, voluntary error reporting from staff, and patient-reported errors in care.

Employee engagement outcomes include surveys that can be quantified.

Driving Outcomes Measures

Driving outcomes measures requires a combination of leadership best practices and evidence-based practice with the patient population.

To drive outcomes measures in performance, nurses need to monitor several factors at once, including patient readmission rates and mortality rates within the patient population. An additional indicator that would be important would be one derived from Medicare, such as total cost expenditures per patient. To drive outcome measures, it would be important to pay attention to other performance metrics, including those that address quality of care such as lifestyle counseling and preventative interventions for at-risk patients. The workplace environment, job characteristics, and institutional supports all contribute to measurable performance outcomes.

Driving outcomes measures to improve quality of care requires a dependence on evidence-based practice, a reinvigoration of nurse training, and additional indicators to monitor outcomes such as patient family surveys to evaluate perceptions of care quality. Quality-of-life factors including mental health and social functioning would also serve as additional indicators nurses could use on a qualitative level, with quantitative indicators including vital signs measurements such as BMI/weight-related issues and heart health measures. Another additional indicator would be to quantify the number of direct patient referrals — the critical word-of-mouth marketing that a healthcare organization depends on for its long-term success and financial performance. Nurse leaders can drive quality of care improvements by making changes to institutional policies, technologies, and job characteristics.

Patient safety remains one of the easier outcomes measures to quantify. In addition to core indicators like equipment efficacy and error reporting, nurses can also drive outcomes through the implementation of a no-fault error reporting system. The no-fault error reporting system would encourage nurses to report errors immediately without fear of reprimand, allowing appropriate corrections to be made in a timely and honest fashion. Technology, organizational supports, and leadership all drive patient safety outcomes.

Employee engagement is known to be a "prerequisite for high performance" (Lowe, 2012, p. 29). Engaged employees increase overall job satisfaction rates, which means higher morale, commitment, camaraderie, reduced absenteeism, and reduced turnover rates. Therefore, to properly measure employee engagement, it is critical to operationalize the definition and construct different survey instruments and means of measuring engagement outcomes. Individual interviews with employees are helpful but primarily yield case-by-case qualitative data that is difficult to incorporate into the balanced scorecard. Simpler, more straightforward metrics are preferable for generating performance snapshots and for communicating results to hospital administrators. Exit interviews, surveys, and online questionnaires that are brief and that encourage honest, forthcoming responses would all help administrators measure employee engagement systematically over time.

Scorecard Advantages

Although it includes several more performance outcomes than strictly required, this scorecard nevertheless focuses on only four main areas: employee engagement, patient safety, quality of care, and performance measures. Each area is then broken down into sub-categories with clearly defined measurable outcomes. The benefits of using this particular balanced scorecard include the following.

1. Data-Driven. This scorecard depends on measurable, quantitative outcomes. Even the surveys administered to patients and employees require measurable data outcomes that can be used to inform company policies and practices. In the evidence-based practice landscape, having data-driven performance outcomes is crucial.

2. Consistent. This scorecard includes multiple elements that all tie together to describe one single patient population: seniors who have been diagnosed with Type II Diabetes. Within this patient population, nurse administrators can examine specific ways of improving performance outcomes in order to meet the self-defined objectives and goals of the organization.

3. Clear. This scorecard includes several metrics that clearly and accurately encapsulate what they intend to measure. For example, equipment failures can be tabulated over the course of each month, as can mortality rates. These clearly defined performance indicators are measured using methods with strong internal validity, regardless of whether they can be applied to other patient populations.