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Volume 50, Number 4
July/August 2005

  • INTERVIEW
    Interview with RADM (Retired) Steven E. Hart, D. O., FACHE, United States Navy, Kyle L. Grazier
  • FUNDING
    The Effect of Capital Requirements on Product Line Profitability, William O. Cleverley and James O. Cleverley
  • COMMUNICATION
    The Power Image: Strategies for Acting and Being Powerful, Paul Preston
  • HILL-ROM ESSAYS
    Addressing Variation in Hospital Quality: Is Six Sigma the Answer?
    Tanisha D. Woodard
    The Plight of the Not-for-Profit, Bramer Owens
  • ARTICLES
  • A Comparison of Systemwide and Hospital-Specific Performance Measurement Tools, Clarence Yap, Emily Siu, G. Ross Baker, and Adalsteinn D. Brown
    View appendixes in issue 50:4
  • An Exploratory Study of Healthcare Strategic Planning in Two Metropolitan Areas, James Begun and Amer Kaissi
  • Fellow Project
    Implementation of a Contractual Relationship for Anesthesia Services in an Acute
    Care Facility, Marcia Taylor

 

Executive Summary
A Comparison of Systemwide and Hospital-Specific Performance Measurement Tools, Clarence Yap, Emily Siu, G. Ross Baker, and Adalsteinn D. Brown

Balanced scorecards are being implemented at the system and organizational levels to help managers link their organizational strategies with performance data to better manage their healthcare systems. Prior to this study, hospitals in Ontario, Canada, received two editions of the system-level scorecard (SLS)—a framework, based on the original balanced scorecard, that includes four quadrants: system integration and management innovation (learning and growth), clinical utilization and outcomes (internal processes), patient satisfaction (customer), and financial performance and condition (financial). This study examines the uptake of the SLS framework and indicators into institution-specific scorecards for 22 acute care institutions and 2 non-acute-care institutions.

This study found that larger (teaching and community) hospitals were significantly more likely to use the SLS framework to report performance data than did small hospitals (p < 0.0049 and 0.0507) and that teaching hospitals used the framework significantly more than community hospitals did (p < 0.0529). The majority of hospitals in this study used at least one indicator from the SLS in their own scorecards. However, all hospitals in the study incorporated indicators that required data collection and analysis beyond the SLS framework.

The study findings suggest that SLS may assist hospitals in developing institution-specific scorecards for hospital management and that the balanced scorecard model can be modified to meet the needs of a variety of hospitals. Based on the insight from this study and other activities that explore top priorities for hospital management, the issues related to efficiency and human resources should be further examined using SLSs.

Executive Summary
An Exploratory Study of Healthcare Strategic Planning in Two Metropolitan Areas, James Begun and Amer Kaissi

Little is known about empirical variation in the extent to which healthcare organizations conduct formal strategic planning or the extent to which strategic planning affects performance. Structural contingency and complexity science theory offer differing interpretations of the value of strategic planning. Structural contingency theory emphasizes adaptation to achieve organizational fit with a changing environment and views strategic planning as a way to chart the organization’s path. Complexity science argues that planning is largely futile in changing environments.

Interviews of leaders in 20 healthcare organizations in the Minneapolis/St. Paul, Minnesota, and San Antonio, Texas, metropolitan areas reveal that strategic planning is a common and valued function in healthcare organizations. Respondents emphasized the need to continuously update strategic plans, involve physicians and the governing board, and integrate strategic plans with other organizational plans. Most leaders expressed that strategic planning contributes to organizational focus, fosters stakeholder participation and commitment, and leads to achievement of strategic goals. Because the widespread belief in strategic planning is based largely on experience, intuition, and faith, we present recommendations for developing an evidence base on healthcare strategic planning.