GUEST
ARTICLE - Sue VanderBent
Balanced
Scorecards for Members
An Association Success Story
Who is the OHHCPA?
OHHCPA is an organization of over 30 home health and social care service providers in Ontario employing 30,000 Ontarians and delivering care to over 100,000 clients annually. OHHCPA members deliver nursing care, home support services, personal care, physiotherapy, occupational therapy, social work, dietetics, speech language therapy and medical equipment in the home. OHHCPA members are contracted by all three levels of government, Community Care Access Centres, insurance companies, corporations, institutions such as hospitals and long term care facilities and private individuals.
What is the Balanced Scorecard?
Developed in the early 1990's by Drs Robert Kaplan and David Norton, the balanced scorecard was created as a new approach to strategic management. The balanced scorecard approach provides a clear prescription as to what companies should measure in order to 'balance' the financial perspective. The balanced scorecard suggests that we view the organization from four perspectives:
Balanced scorecards translate strategy into action and help organizations and groups achieve goals. In the health care field the increasing use of balanced scorecards has become more evident since the mid 1990's.
Overview of the OHHCPA Standard Development
In 1996, along with vision, mission and value statements, the Association completed a written set of standards for members that measured all aspects of home health care management, administration and service delivery. Membership in the OHHCPA was contingent on members agreeing to follow the Association standards. It was agreed that the standards could not include accreditation processes that relied on inspection of individual companies due to the competitive nature of the home care sector in Ontario.
By 1999, the Association was searching for a way to take its strategic planning and association standards to a higher level.
Why a Balanced Scorecard for an Association?
The balanced scorecard development was a visible way for the Association to increase its standard development and to assist members in their own quest for further standard development. The balanced scorecard was also seen as an important way for OHHCPA members to demonstrate public accountability to standards of excellence and transparency in reporting areas where support was needed for Association members. The completion of the balanced scorecard was established as one of the key quality compliance standards for Association membership.
Methods Used to Develop a Scorecard
To facilitate the development of a balanced scorecard, the Association created a "Quality Template" that essentially took the existing OHHCPA standards and translated them into a template based on the Balanced Scorecard quadrants. (A sample of the kinds of questions and the appropriate reference to existing OHHCPA standards accompanies this article). A committee of Association members who had expertise in the quality management area undertook this intricate and lengthy process. It was found that this task was best accomplished by individuals who were conversant with the existing Association standards and were able to cross-reference standards so that they were applicable in the Balanced Scorecard format. Because this was seen as a very important undertaking by the Association, the Board of Directors of the OHHCPA was quite involved in this process and reviewed the work of the committee along the process of development.
Using a total quality management and continuous learning approach the Quality Template established four levels of self-rated compliance: Substantial, Partial, Minimal, Non-compliant and Not Applicable. For the Not Applicable level, members are asked to explain
reasons.[1]
Once the Quality Template had been created and introduced, members were directed to submit the template as part of their annual membership renewal process. Continued membership in the Association was made contingent upon the receipt of the Quality Template. Individual members were also able request a confidential report of information from the Quality Template in relation to their individual compliance measured against total membership compliance.
In addition to gathering the results of members' independent self-assessments in a balanced scorecard format, the OHHCPA Balanced Scorecard provided an annual opportunity for the Association to report to membership, key stakeholders and the public. Data related to the four quadrants is collated by staff and prepared for presentation on the website and the Association newsletter.
Uses of the Balanced Scorecard
In the annual Balanced Scorecard Report to the Community, the OHHCPA outlines the collective results of members' surveys and provides an interpretation for readers. Using a continuous quality improvement approach, areas of partial compliance are probed in order to elicit ways in which the Association can be helpful to its membership. For instance, in the 2001 and 2002 Balanced Scorecard Report, members had very high scores in the Customer, Internal Business and Financial perspectives. However, members reported difficulty with the Learning and Growth Perspective, specifically in the aspect of utilizing current published research and greater opportunity to participate actively in publicly funded research opportunities. As a result of this finding, the OHHCPA now regularly reviews current home health care research in Board meetings and publishes home care research on its website. In addition, the OHHCPA is actively pursuing opportunities to participate in publicly funded research opportunities. The need continues for OHHCPA members and the Association itself, to participate as equal partners in provincial and federally funded research opportunities. Finally, findings from the Balanced Scorecard are discussed in annual strategic planning session of the Board and used as a guide to assist Association activities.
Benefits of the Balanced Scorecard
There are a variety of other uses for a Balanced Scorecard in association management and membership recruitment and recruitment
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The OHHCPA has found the introduction of the Balanced Scorecard to be a useful planning and advocacy tool at the political and government level. The Ministry of Health and Long Term Care in Ontario has asked for information about the OHHCPA Balanced Scorecard to prepare for the value-for-money review prepared by the Provincial Auditor
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Development of the scorecard has also been a significant factor in allowing insurance companies to offer reduced rates to members because it is seen as a continuous quality improvement tool that supports overall quality management of the sector.
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Association members who compete for service volumes through the Community Care Access Centres (CCAC) have used membership in the OHHCPA and the maintenance of the Balanced Scorecard as credentialing for their proposal.
Conclusion
All members of the OHHCPA continue to strive for increased quality in order to be able to serve their customers effectively and efficiently. The OHHCPA Balanced Scorecard is an important tool to provide a broad overview of members' compliance with important and on-going aspects of quality management. In the past years, the majority of OHHCPA members have begun to pursue additional external accreditation processes such as the Canadian Council of Health Services Accreditation (CCHSA) and ISO (International Standards Council). These members have cited the work of the OHHCPA in the creation of the Balanced Scorecard as part of their existing quality management activities. OHHCPA members believe that external accreditation will be a complementary addition to the important quality work already collectively undertaken by the Association through the introduction of its own Balanced Scorecard.
Sidebar: Sample
Quality Template
[1] Reflective self-assessment is an accepted form of measurement by professional colleges
(eg. College of Nurses) as a way of encouraging life-long learning and continuous quality improvement processes within membership. Accepted practice in the ISO 9000 quality measurement process begins with an objective self-review of the organization which is followed by periodic assessments against standards.
Sue VanderBent
is executive director of OHHCPA. Sue can be contacted at
905-543-9474 or by e-mail at suevan@HomeCareOntario.ca.
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