The CAMH Balanced Scorecard The Bumpy Road From Theory to Practice Amanda Robins, M.A., Director, Clinical Operations Peggie Willett, M.A., Director, Decision Support October 22, 2008
Overview Background Early Development Changes Over Time Clinical Scorecard CEO Goals/Strategic Directions Challenges Clinical Perspective How Scorecard is used Next Steps
In the Beginning There were four organizations 2 mental health (Queen St Mental Health Centre, the Clarke Institute) 2 addictions (Addiction Research Foundation, the Donwood Institute) As part of the hospital restructuring in Ontario, the four organizations became the Centre for Addiction and Mental Health
New Accountability Merger brought many challenges Four different cultures Lots of fear and resistance Also brought excitement and new ideas Accountability and reporting Balanced Scorecard framework chosen
6 Task Groups formed Development of BSC HR, Clinical, Risk, Operational, Community Health & Education, Transition/Merger Consultations with senior management Learning process Many of us were new to mental health, and new to hospitals Learned that many standard hospital indicators didn t apply to mental health and addiction in the same way as acute care Timeline a challenge Approximately 6 months to produce the first report
Development of BSC Managing expectations was an issue Priority setting exercises re identified indicators High 1s, High 2s More challenges Four different systems No central data source Data could not be linked No way of knowing whether Jane Doe at Donwood was the Jane Doe at the Clarke Institute, etc. Problem getting buy-in from many staff BSC seen as flavour of the month
First Scorecard First scorecard was met with excitement In spite of limitations, first time information from all four sites was pulled together Most of the data was categorized as low or medium quality Decision Support discovered it was about more than pulling information together Projects initiated to: Define processes Design forms & databases
Later Editions Over time the scorecard got buzz CEO was a major supporter and took it with him to external meetings Became the place for departments to publicize what they were doing Political implications Some departments were more data rich than others Not indicator based
The Tipping Point Scorecard got bigger and bigger It was time to change New rules instituted Had to be an indicator (or at least a number) Compared where possible to targets Summary page mimicked a dashboard Benefits More succinct Drawbacks Lost richness No information provided at the clinical program level Work of some portfolios not included
Clinical Scorecard With loss of clinical info in the corporate scorecard there was an obvious need for a clinical report Working with Clinical Programs we designed a report that would relate specifically to clinical areas E.g. Medication incidents on clinical report do not match medication incidents on corporate report In Excel format Four standard quadrants Hyperlinks to program info Key indicators from clinical scorecard make up the clinical dashboard
CEO Goals/Strategic Directions In the meantime CEO establishes his goals at the end of Q4 CAMH also went through a strategic directions renewal process Promised the Board we would monitor progress Have managed to merge the CEO goals & strategic directions monitoring into one report CEO Goals report generates attention Executive leadership team meets quarterly to discuss Result CEO Goals report is the living document Balanced Scorecard has become a static report
Challenges TOO MANY INDICATORS Victim of success Redesign the Balanced Scorecard Incorporate the CEO Goals Review Clinical Scorecard Which indicators are being used? Which can be let go? Production is a manual process No corporate reporting system Decision Support is a small department
The Clinical Perspective
Corporate BSC focused on all areas of CAMH, not just clinical care functions Needed consolidated information to tell the story Developed Clinical BSC Measured inpatient and outpatient activity across 4 quadrants Quickly identified areas for improvement and challenges
Helped measure impact of patient safety and quality care initiatives in a cohesive, reportable way Quick Reference to HAA indicators (patient days, separations, outpatient/er visits, FT nursing ratio) Challenged by length of report (for quick reference): Developed Clinical Dashboard to highlight fiscal year indicator focus Followed red, yellow, green measurement formula Clean and concise
Every year, Clinical BSC is refined with Dashboard New targets identified and defined Baseline year, if new initiative or no targets Indicators re-defined or removed if necessary These documents influence and are influenced by CEO Goals/CAMH Strategic Directions document Looked at in conjunction, these 3 documents tell story of Clinical Programs activities
Highlighted special areas of focus that were developed as we became more sophisticated: Long Stay Clients ALC Falls Prevention Medication Reconciliation Metabolic Monitoring Restraint Reduction Complaints about Quality of Care Under development: Wait Times strategy Programming Hours Improved ALC RAI compliance
Next Steps Ensure clinical program managers are aware of and understand document and its value market to the masses Communication plan Data quality improvements and process redesign Newly established Data Quality Council Other influences E-HR and Case Costing initiatives
Thank You Questions?