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Business Process Perspective What was the process of creating a BSC at Duke Childrens Hospital? Implementation BSC aligned hospital goals around four quadrants: financial health, customer satisfaction, internal business procedures, and employee satisfaction. It was explained to the hospital employees that all quadrants are equally important and an equal amount of effort should be put into each of them. If there was not enough done in one quadrant, and too much in another, it would give a mis balance to the entire organization. There has been created a measurement system for each of the four balanced scorecard quadrants. DCH implemented a group approach, where roles of staff members shifted from simply being a nurse or being a surgeon, to being a team of ICU specialists that helps children with heart problems.
This approach gave staff more incentives to gather and discuss each case in detail, taking into account opinions of management, nurses and doctors equally. The groups also created clinical pathways steps to performing each kind of treatment, which, in turn delegated many procedures from doctors to nurses (e. g. removing a patient from a respirator without having a therapist present).
Clinical protocols have also been composed, stating the amount of laboratory tests and treatment to be received for a certain condition. Why did the hospital decide to take on this process? What was the reaction of the staff? In the years 1992 - 1996, Duke Childrens Hospital was having serious financial problems. In the fiscal year 1996, they reported an operating loss of $ 11 million, which forced the administration cut back on resources. This resource cut-back meant deterioration of quality of clinical care, increase in customer complaints, dissatisfied staff.
The main problem at the DCH was that: each group, from accountants to administrators to clinicians, was focusing on its individual goal rather than on organization as a whole (Jon Meliones). The DCH management was thinking as a money-loosing non-profit organization, instead of thinking as a profitable corporation. When BSC was first implemented, doctors and managers did not like the idea of being in teams with nurses and other medical staff. They felt that being in a team and delegating some functions was a shift in their power and many of them opposed this shift. However, once the success of BSC became obvious (within the 6 month after implementation of BSC, the hospital reached impressive results: customer satisfaction rose by 8 % and cost per case was reduced by 12 %), even the worst skeptics started to cooperate and put tremendous effort into the mutual cause. What internal business processes did Duke Children's Hospital focus on?
What changes were made? The first thing that was done at DCH was setting realistic, at the same time, ambitious goals (e. g. length of hospital stay has to decrease by 10 %, 20 %, etc. ). Each staff member was a part of the team that had to reach these goals, which empowered people, raised their morale and gave them motivation. Moreover, employees got an opportunity to participate in on-line discussion groups, state their suggestions and proposals in the employee newsletter, participate in more social events, best team members of the month were honored.
DCH started to use Strategic Vision software (own database and accounting system) for collecting, storing and analyzing the information. The new approach to data-processing, which allowed analyzing all information, not just a misleading part (only partial information has been analyzed before) of it, has been implemented. The program showed each customers illness and treatment history, expenses, waiting time for admission and discharge, complication rates, etc. Moreover, usage of IT gave an opportunity to compare the DCH results to the average national results, which, in turn demonstrated what areas needed improvement. Customer satisfaction rates have been raised with the help of patient care guide, which explained what should be done and expected on each day of clinical stay of little patients. All offices, rooms and staff have been supplied with identification cards naming doctors and nurses, which made staff-customer communication much more effective.
DCH also offered its customers to cut their medical expenses by staying at a hotel instead of at the hospital while awaiting surgery. In terms of financial indicators, DCH also succeed very much. Besides a tremendous raise in profits (from -$ 11 mln in 1996 to +$ 4 mln in 200), the hospital showed much higher number of patients submitted, treated and released. The cost per patient significantly went down from nearly $ 15000 per patient in 1996 to $ 10500 in 2000. 4.
Describe the interactions between these business process changes and impacts on employees, customers (patients) and the financial perspectives. The main goal for BSC implementation was to equally concentrate on financial health, customer satisfaction, employee satisfaction and internal business procedures. Customer satisfaction was been reached by providing improved clinical care and more communication to patients. Employee satisfaction rose due to the empowerment and positive results of their work. This would have been impossible without good internal business procedures, such as new techniques of cutting on cost of stay, length of stay, etc.
as it eliminated many unnecessary expenses and allowed to convert this money into cost savings. Improved business procedures have led to profit-making, and, consequently, to financial health of DCH. The above is based on Saving Money, Saving Lives by Jon Meliones Duke Childrens Hospital BSC case study.
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Research essay sample on Childrens Hospital Employee Satisfaction
