Table of Contents
- The Organization’s Strategic Plan
- The Organization’s Accrediting Body
- Presentation of the Scorecard
- Learning and Growth
- Internal Business Processes
- Evaluation of the Scorecard
- Defining the Value of the Scorecard
- Explanation of the Measures
- External Benchmarks
- Relationship to the Strategic Plan
- Related Management essays
Regardless of the fact that any organization in healthcare or other industry promotes quality of service delivery as its primary objective, numerous elements of organizational performance may prevent the staff from achieving this purpose. In case the service provider fails to address the issue or ignores the problem, high competition in the sector may result in the loss of market position and consumer base among other consequences. For this reason, it is important to find appropriate tools for the analysis of organizational performance, detection of potential flaws in its operations, adjustments in its management strategies and ensurance of smooth and well-planned transition to more quality service provision. In particular, Balanced Scorecard (BSC) can be regarded as “a popular innovation” (Nørreklit, Nørreklit, Mitchell, & Bjørnenak, 2012, p. 491) and a “best known and most widely used framework for performance measurement” (Amado, Santos, & Marques, 2012, p. 391). This model is applied in order to “align business activities to the vision and strategy”, “improve internal and external communications” and “monitor organizational performance against strategic goals” (Grigoroudis, Orfanoudaki, & Zopounidis, 2012, p. 104). Thus, the purpose of this paper is to evaluate the alignment of strategic plans with the performance of Twin Valley Behavioral Health (TVBH) in terms of quality in light of BSC as one of the most appropriate approaches to holistic organizational improvement.
The Organization’s Strategic Plan
The organizational strategic plan defines the nature, direction and essence of the organizational performance. According to the TVBH’s strategic plan, the management aims to ensure that the functioning of the facility is multidimensional and thorough at the same time. To be more precise, the entire set of operations of this mental healthcare institution targets the commitment of the staff to continuous enhancement of quality as the main strategic objective. The organization aims to ensure that the treatment administered to the patients is evidence-based and effective. Moreover, the strategic worldview promoted by the service provider is thoroughly risk-minimized and safety-oriented in order to achieve a twofold aim, such as deliver the customer-centered care effectively and mitigate any potential errors in the process. While consumer needs are regarded as primary determinants of the service provision, the organization is committed to ensuring timeliness, efficiency, proper-level coordination and continuity within the framework of service delivery.
Therefore, having given a brief overview of the major strategic orienteer for the staff, quality has to be perceived as a given by the personnel, and its core involves several components. First and foremost, as it has been mentioned earlier, customer focus is an initial stage of any in-hospital activity. With a reference to the strategic plan, TVBH ranks itself as a high-quality mental healthcare provider. As a result, meeting and exceeding the needs of both internal and external consumers is the central purpose of TVBH'. Secondly, making sure that each service and activity related to treatment intervention is recovery-oriented is set as another strategic objective. This point in the plan is accompanied by an expanded service portfolio, involving (a) promotion and preservation of wellness, (b) a broadened scope of services, and (c) development of flexible, individual-based strategies. Third, employee empowerment and leadership involvement are intertwined and significant constituents of TVBH’s strategic plan. The first part of this objective relates to thorough engagement of all-level staff members in fulfillment of the mission and vision of the organization as well as alignment with the strategic plan points. Additionally, the second part means both involvement in the process and permanent control over the procedure. Fourth, service delivery is data-informed. Thus, the personnel should not take for granted a necessity to collect statistics of service delivery within the practice and up-to-date academic research on the topic. An emphasis has to be on advantageous and disadvantageous indicators in order to ensure continuous quality growth.
According to the above review of strategic initiatives guiding the operations of TVBH, it is evident that the organization aims at achieving high-level and holistic quality with respect to individuals it is devoted to working with. Hospital management has developed a multidimensional outline of its working environment and appropriate domains of functioning whereas all crucial elements of healthcare delivery have been incorporated. Indeed, the plan considers major stakeholders, such as providers and consumers, which creates a uniting approach for a well-organized and trustworthy service delivery partnership. Quality cannot be achieved if the treatment is positioned as a one-sided procedure, namely, when a client is supposed to follow the provider’s directives blindly. Hence, an informed treatment, when the customer is an active participant of the process, is undoubtedly perceived as an embodiment of the holistic quality care. What is more, the content of the plan evidences that the organization emphasizes continuity of quality improvement. This goal is to be pursued by constant review of the practice procedures and outcomes in order to provide better results and permanent growth of professionalism and qualification of the staff members.
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The Organization’s Accrediting Body
TVBH is a healthcare organization accredited in accordance with the standards and requirements of the Joint Commission Accreditation (TJC). Drawing upon the academic research, the Joint Commission accredits “approximately 82% of US hospitals representing 92% of hospital beds” (Schmaltz, Williams, Chassin, Loeb, & Wachter, 2011, p. 454). In this respect, the level of qualification of this agency should not be doubted. Following the results of the qualitative inquiry by Alkhenizan and Shaw (2011), the accreditation of medical institution leads to “improving the structure and organization of healthcare facilities” and significant improvement of “clinical outcomes and the quality of care” (p. 407). Moreover, the studies have evidenced that the hospitals that are accredited by the TJC have better performance, gains and outcomes (Schmaltz et al., 2011). Although accreditation itself is a voluntary procedure, obtaining such a status requires compliance with a number of strict rules concerning different dimensions of organizational performance. By the same token, this creates allows a range of benefits for an accredited organization in light of high-quality healthcare delivery. From the consumer’s perspective, the TJC accreditation implies strengthened patient safety and confidence in advanced and relevant care provision among other advantages (Schmaltz et al., 2011). For TVBH, the accreditation means but is not limited to constant compliance with high-quality, risk-management and legal requirements, and resultant excellent performance. Therefore, besides self-sufficient positioning in the sector that is embedded in TVBH’s strategic plan, the organization is committed to abiding by the quality standards maintained by the TJC as a credible and highly authoritative body.
Presentation of the Scorecard
As it has been indicated previously, BSC is applied for the evaluation of TVBH’s adherence to the approved strategic plan and the quality of its operations. The assessment is conducted within several dimensions. The analyzed domains include (a) considerations regarding learning and growth within the organization; (b) internal business processes; (c) customers; (d) financial issues.
Learning and Growth
Based on the fact that the strategic plan clearly emphasizes constant increase in healthcare delivery quality, learning and professional growth is the best means to achieving this aim. The updated objective can be outlined as the creation of knowledge-sharing environment as a primary way for pursuing high-quality performance and continuous enhancement of operations. This procedure may be extended for up to six month, but it requires permanent monitoring and flexible character to be updated about the identified necessities in the process of implementation. In this regard, the following measures should be undertaken:
- to conduct constant assessment of the employee’s needs and concerns, their job satisfaction level and other attributes of quality performance;
- to organize trainings for the identified needs;
- to arrange sessions between employees of different departments to share knowledge, experience and skills as a way to engage them in mutually beneficial decision-making and organized collaborative practice.
Internal Business Processes
This domain allows to determine the extent of business operations and their efficiency, as well as detect potential strengths, weaknesses and opportunities for the growth of an organization (Amado et al., 2012; Grigoroudis et al., 2012). Hence, the objective can be linked to the alignment of processes within the organizational structure. Namely, each department and every specialist in that department should perform a set scope of duties, while employee sessions will promote better awareness of service provision from different perspectives. On a similar note, the previously introduced shared-knowledge approach requires collaboration. Thus, proposed informativeness based on well-aligned and differentiated operations will result in time-efficient decision-making and collaborative effectiveness of care delivery. As a result, this objective should incorporate the following measures:
- upgrading internal communication strategies throughout the departments and an organization as a whole;
- discussion and sessions devoted to quality concerns and proposals based on exchange between departments.
The firm anticipates a challenge of decreasing the rates of falls by 50% within the next six months and working on further reduction measures in terms of this indicator. Following the rationale by Perkins, Prosser, Riley and Whittington (2012), physical restrain, as the primary approach to addressing the issue of these falls in TVBH, is “cohesive and traumatic procedure” for the target patient group (p. 43). Hence, the quality of care, in this regard, is directly undermined. In order to achieve the outlined objective, there is a need to:
- review the current physical restraint policies, evaluate the relevance of physical restraints based on the hospital-wide evidence and frequency of falls and minimize their amounts;
- discuss the nature and characteristics of the most frequent incidents within the institution and eliminate the risks for the patient’s falls;
- apply the updated anti-fall policies, monitor the results on a monthly basis and make adjustments if necessary.
In the light of financial perspective, the management ought to consider and evaluate the organization’s internal cash flows to raise funds for employee training and professional growth with regards to quality service provision. To pursue this objective, it is necessary to:
- clarify TVBH’s internal financial opportunities in terms of operations and investments;
- allocate the funds for employee education;
- seek for investors/partners to arrange training in case the internal cash flows will not be enough for achieving this objective.
Evaluation of the Scorecard
By aligning the aforementioned set of BSC-related objectives and TVBH’s strategic plan, the practical implementation reveals that the well-framed theoretical background is not enough for ensuring high quality. The strategic plan is rather blurred from the learning and growth perspectives. Undoubtedly, it emphasizes a vital role of training for clinical and administrative staff regarding continuous quality improvement and specific initiatives. This parameter partially corresponds to one of the measures identified in the scope of creation of a shared-knowledge environment. Simultaneously, the developed BSC demonstrates the necessity for a more detailed vision of this important factor in organizational performance with regards to quality as a critical goal. In accordance with internal business processes, the strategic approach of TVBH has also been expanded by the means of BSC. However, while the previous part was at least broadly referred to in the plan, the process alignment was not mentioned in its context, notwithstanding that this measure was important for maintenance of smooth and efficient internal operations. Next, there are high fall rates among the patients along with numerous physical restraints to be followed. Moreover, this objective is identified as one of the main priorities, though the percentage in fall reduction is lower for the year-long period - 30%. In addition, this concern is related to the recovery-based quality principle that the organization aims to follow.
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Finally, while the issue of training is considered as a crucial goal to pursue by the management, financial aspects are not covered by the strategic plan at all. Thus, it follows that the overall developed BSC has offered an expanded and more detailed overview of the supplementary factors capable to contribute to TVBH’s improved performance.
Defining the Value of the Scorecard
Drawing upon the introduced BSC, it will be possible to enhance TVBH’s performance by facilitating its “patient,” “clinical” and “capability/capacity focus” (Grigoroudis et al., 2012, p. 106). Undoubtedly, the proposed objectives and measure are likely to facilitate the organization’s commitment to a more quality care that will be both holistic and integrated. To be more precise, the outlined points clearly demonstrate the interconnectedness of all stakeholders in relation to the organizational capabilities to meet their needs. This task to be accomplished through their involvement in the quality enhancement process as decision-makers and implementers of goals for the common good. Therefore, the BSC can add consumer- and employee-focused value to the organization along with increased levels of community trust and confidence. Moreover, more competitive positioning among service providers can be granted.
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Explanation of the Measures
It is necessary to note that all of the measures and objectives to be pursued are aimed at the establishment of the integrated and thorough quality care delivery within the organization. In particular, TJC constantly emphasizes a vital role of development of patient-safety culture within the accredited facilities. Hence, the proposed customer-oriented objective in the BSC and the measures to be undertaken within its scope includes proper approaches to compliance with this standard in the long run. Moreover, all other objectives have been introduced to supplement the indicated standard in a multifaceted manner. Namely, patient-safety culture should be perceived as quality care delivered by qualified professionals who are satisfied with their jobs. Whereas the BSC positions imply training and enhanced interpersonal communication in the context of shared-knowledge framework development, these factors presume the quality of care delivery. Finally, based on the fact that permanent training opportunities are impossible without funds, the financial constituent of the BSC allows to fill this gap. Thus, the implementation of the proposed BSC model will definitely enable the creation of patient-safety and quality culture in TVBH.
In order to make sure that the strategy based on the developed BSC is implemented properly, it is necessary to plan, evaluate, practice, monitor and adjust the framework as a flexible and well-thought-out procedure. Therefore, such goals can be pursued in the next three years:
- conducting a preliminary evaluation of the consumer and employee needs and requirements as a background for the operational update;
- communicating the results of evaluation to the staff and conveying a necessity to change;
- collecting the proposals in terms of improvement throughout the departments and explicating them to the general personnel in order to come up with the mutual course of action;
- evaluating financial capabilities for personnel education and engaging in external partnerships for this purpose;
- developing and scheduling trainings;
- implementing the proposed strategy on a step-by-step basis;
- monitoring the results on the three-months (during the first year) and later - annual basis, and making adjustments in the policies;
- improving the general service provision quality through an integrated performance framework;
- reporting the results and shortcomings to both staff members and the public.
Relationship to the Strategic Plan
Following the reasoning behind the BSC, it is relevant to assert that this framework will allow expanding the scope and extent of TVBH’s operations and improving the quality of its performance to a great degree. Specifically, the issue of collaboration and shared knowledge is a centerpiece of the strategy, which is most likely to contribute to this process. Additionally, a nurse’s role can become more than sufficient in this respect, especially from customer and learning and growth perspectives. In particular, one can report the issues that require immediate attention with regards to patients’ falls and opinions about how to address these concerns. Moreover, the presence of an active participant and a role model in the transition to a shared-knowledge practice is another way to facilitate the implementation of change.
All in all, the BSC developed in the paper has showed the relevance of this model in terms of enhancing quality in the mental healthcare setting. Regardless the fact that the strategic plan of the analyzed organization has already been substantially quality-oriented, the BSC can broaden the scope of its implementation. In this way, it will be possible to create a holistic and integrated service delivery system which takes into account the needs of the main stakeholders and makes them active participants and decision-makers in the process of care.
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