Introduction

In 1996, Drs. Robert S. Kaplan and David P. Norton developed the theory behind the Balanced Scorecard. Harvard Business School Publishing says, "The Balanced Scorecard translates a company s vision and strategy into a coherent set of performance measures Kaplan and Norton provide the theoretical foundations for the Balanced Scorecard and discuss how the Balanced Scorecard can be used as a driver of change."

The Balanced Scorecard is a current management tool that is used to identify valuable and measurable contributions to an organization. Bain and Co. estimates that over 50% the "Global 1000" are currently using some form of Balanced Scorecard methodology. As healthcare becomes less community hospital-based and more "health system" based, the executive management of these large healthcare systems will be using best practices in managerial method. This is not to imply that its applicability is limited to multihospital systems.

In today's healthcare environment, there is continuous pressure to reduce the cost of delivering healthcare while improving the quality of that healthcare. Frequently, these pressures may result in issues of importance to the organization to be overlooked (i.e. employee satisfaction with personal safety). As practitioners of the art and science of health and safety, we must have the tools at our disposal to illustrate to management that our recommendations, programs, and projects are valuable to the organization's overall balance.

The key foundation theories of a Balanced Scorecard (Financial Measures, Customer Perspective, Internal Business Process Perspective, Learning and Growth Perspective) can be used to address issues identified in Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards, National Fire Protection Association (NFPA) standards 99 and 101, as well as the regulations and standards established by Authority Having Jurisdiction (AHJ). As seen in the chart below (Table 1), the Balanced Scorecard is not limited to a project or department nor does it have a singular focus, but rather facilitates multiple systems in a wide enterprise as we are presented with in the healthcare environment of today.

Table 1 (available in full paper)

Discussion

In 1999, the estimated expenditures on healthcare were roughly 14% of the US GDP. As a serviceoriented business, unlike other services, healthcare offers a "product" that their customers can seldom go without. There is still a competitiveness that exists in order to attract the highest qualified staff, the most well known physicians and achieve the highest reimbursement rates. Much like other businesses, healthcare uses differentiation and specialization to reach key markets. However, standards of care for more routine health issues are fairly well established and beyond differentiation. One area that can vary within the standard operation is the safety of that operation.

Safety of and in a healthcare facility/system is a complex issue. Organizationally, the safety operations may be in a divided among a variety of different departments. Safety may be part of a larger Safety & Security Department. Occupational health for employees may be in an Employee Health Department. Visitor concerns or complaints may be handled by the Risk Management Department.

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