Balanced Scorecard Expanding its Reach
Obstetrics Division Chief David Acker, MD, this summer turned to the Balanced Scorecard to examine his division’s performance on episiotomies. The data showed variations among physicians of 5 percent to 40 percent.
“The Scorecard shows what everyone’s data is, and it allows us to scratch our heads and look at the variances,” Acker said. The difference in episiotomy rates among the obstetricians could not be explained by differences in patients. “It was not because some of us were delivering bigger babies,” Acker said.
In Obstetrics, the sharing of episiotomy data prompted an inquiry and division-wide discussion on quality improvement. “And what’s equally important to looking at this specific data, it has opened the eyes of many of our physicians to the Balanced Scorecard and how to use it,” Acker said.
As of this summer, more than 1,200 physicians, nurses, administrators and senior leadership now have access to the Brigham and Women’s/Faulkner Hospitals Balanced Scorecard. The Web-based application includes a data warehouse that draws patient-level data from more than 80 sources and displays measures in the four dimensions of service, quality of care, people and financial strength.
“The Balanced Scorecard provides a cascade of data so each department and division, and, in many cases, individual physicians can see how they are performing on specific measures like mortality or length of stay,” said Michael Gustafson, MD, MBA, vice president, Center for Clinical Excellence (CCE). “It allows us to link performance metrics to our strategic goals.”
The Balanced Scorecard now includes physician-level performance data for Surgery, Gynecology, Obstetrics, Orthopedics and Neurosurgery. In the next two months, work will be completed on the Emergency Medicine scorecard, as well as additional quality metrics for Obstetrics and further enhancements to a robust set of Faulkner Hospital cards. The CCE also recently added detailed outpatient statistics by category and cost center to allow tracking versus budget and last year’s performance.
Gustafson said the CCE Decision Support Systems team is working to add ambulatory metrics for the first time to scorecards, which will help improve the relevance for departments such as Medicine, Neurology, Dermatology and Psychology in coming months. After that, Radiology and Pathology have expressed interest in collaborating on enhancing their scorecards. “We’re striving to make sure we can supply accurate and meaningful data for all of these departments over time,” Gustafson said.
In analyzing Obstetrics data, for example, physicians can compare their performance to their department colleagues, G. Troy Tomilonus, manager of Decision Support Systems in the CCE, said.
“The biggest value for a physician is to look at your individual performance and compare it against your peers. If you’re not as productive, you can review the data with your medical director and learn from your peers,” Tomilonus said.
This past summer, the Balanced Scorecard began publishing quality measures with reports based on race, ethnicity and gender. The race and gender metrics include inpatient satisfaction, Emergency Department satisfaction, 14-day readmission rates, in-hospital raw and risk-adjusted mortality rates, ambulatory HEDIS scores, raw and risk-adjusted length of stay, discharge volume and surgical volume.
“Stratifying performance measures by race, ethnicity and gender will provide us with new insight into our own performance and how to improve it,” said JudyAnn Bigby, MD, director of Community Health Programs in the Office for Women, Family and Community Programs.
The push for a hospital-wide, centralized database began in 1999. That’s when Andy Whittemore, MD, took over as chief medical officer with the charge of reducing length of stay. At the time, there were 11 different definitions in six separate and disconnected data sets, Whittemore said.
“That’s emblematic of just how many different sets of metrics we had across the entire hospital. We couldn’t begin working on reducing length of stay until we all agreed on what it was,” Whittemore said.
The BW/F Balanced Scorecard is now the subject of a detailed case study and classroom instruction at Harvard School of Public Health. Eoin W. Trevelyan, DBA, uses the case study in his health policy and management courses for physician leaders from across the country.
The staff in the CCE Decision Support Systems group are available to assist physicians and departments in navigating the Balanced Scorecard and understanding their data. “We’re flexible and ready to accommodate use of the data by each department,” Gustafson said.