Developing a Balanced Scorecard
A Balanced Scorecard
There are many reasons to employ strategic planning tools such as the balanced scorecard (BSC). As nurse leaders, we are responsible for not only the individuals we lead but also the various stakeholders of the organization and keeping them informed on progress and accomplishments. When implementing a new strategic plan, a BSC creates a map that can be easily understood by everyone involved. The BSC is a performance measurement tool that can allow nurse leaders to determine how they will evaluate what they are trying to accomplish (Huston, as cited in Laureate Education, 2013). This discussion will explain my plan for creating a BSC for my strategic plan of developing a Level IV Epilepsy Center, including the processes used to gather data to measure performance. An explanation of how the use of this BSC will enable the evaluation of progress, the impact on the organization, and the cost justification will also be provided.
Developing a Balanced Scorecard
Balancing financial measurements with non-financial measurements can be accomplished through the creation of a BSC, and also provides a comprehensive framework that maps out an organization’s vision and strategy into a set of performance measurements that are easily translatable by all stakeholders (Kolberg & Elg, 2011). Sare and Ogilvie (2010) discussed that a BSC functions to align the organizational mission and vision with the strategic plan. Creating a Level IV Epilepsy Center will require a BSC to map out the fiscal measures, consumer needs, processes and protocols, and growth.
Strategic planning requires the assessment of all financial implications in efforts to capitalize on the benefits and weigh the risks associated with the plan. It is essential that the strategic plan identifies the financial risks to help predict the economic consequences of the plan (Groene, Brandt, Schmidt, & Moeller, 2009). To create a Level IV Epilepsy Center, Gillette Children’s Specialty Healthcare (GCSH) has the potential to generate an additional $8.3 million which after total capital, equipment, and administrative costs are taken into consideration, GCSH still walks away with $5.5 million in the first year. Salaries will be calculated to factor into the financial implications and include an epileptologist, epileptologist fellow, epilepsy nurse practitioner, social worker, neuropsychologist, additional RNs, psychologist, psychometrist, and additional video EEG monitoring technologists. The total cost of the additional staff is $1.1. million, which can be rounded up to $1.2 million to factor in any salary negotiations. Total capital and equipment expenses are estimated at $1.6 million. To succeed financially, I must prove to stakeholders that the Level IV Epilepsy Center will generate enough revenue to make a profit on top of start-up and ongoing expenses.
Business Processes and Protocols
Gillette Children’s Specialty Healthcare is currently a Level III Epilepsy Center with processes and protocols in place to support the internal processes. The business perspective of having a Level IV Epilepsy Center will spotlight the skills and competencies already in place while focusing on improving operational measures with the end goal of improving quality by internal processes. Organizations must remain innovative but must also be able to view and measure the innovation’s success to improve and create value for their customer (Kaplan & Norton, 1992). The BSC that aligns with the creation of a Level IV Epilepsy Center will include the development and revision of new policies and procedures to include the number of staff that respond to an epileptic event, constant EKG monitoring, standby assists when the patient ambulates, and a new policy requiring the patient to remain on VEEG camera in their room, as well as the mandatory tasking that occurs with each event that is currently not in place. Adjusting these internal processes will satisfy stakeholders and allow them the envision how the plan will take shape.
Questions organizations should ask during the strategic planning process are; How are they viewed by their customers, and how will the project improve the customer’s overall perspective? The BSC must align with the organization’s mission and must be translatable into specific measures that signify causes that matter to the customer (Kolberg, & Elg, 2011). According to Kaplan and Norton (1992) customers really care about “time, quality, performance, service, and cost” (p. 73). Tracking and measuring the goal of creating a successful Level IV Epilepsy Center will include gathering baseline scores from customer satisfaction surveys and comparing those scores at intervals after the implementation of the Level IV Center. The cost can be measured by comparing the services GCSH provides with the services of other Level IV Epilepsy centers nationwide. Even if GCSH’s services are more expensive than other centers, if it can provide a higher-quality service or more convenient service, which can be based on customer feedback and surveys, then essentially GCSH will have satisfied the needs of the customer.
Learning and Training
Sustaining GCSH’s capacity to change and improve will require staff buy-in. Gillette will need to invest in the additional staff, equipment, and technology, as well as the training and education that will be required to bring staff up to speed with the new change. Developing the employees’ skillsets to meet the needs of a Level IV Epilepsy Center will require training on the new information technology and training on the new seizure protocols and interview processes. Although not required, employees will be offered reimbursement for completing certification as a neuroscience registered nurse (CNRN), as well as an increase in pay. The more RNs that are CNRN credentialed will not only assist with training but can also cross over into customer service because certification represents a vast knowledge of and experience of the fundamentals of neuroscience.
The use of a BSC will allow for the continuous collection and assessment of data relevant to the development of a Level IV Epilepsy Center. The BSC provides a map for all stakeholders to easily visualize progress in one location versus many. Gillette already uses the Consumer Assessment of Healthcare Providers and Systems (CAHPS) which can assist with measuring satisfaction with the new program, and the Press Ganey Employee Engagement Survey which gauges employee engagement that can also translate to measuring employee satisfaction with the new program. Financial implications can be measured by evaluation of costs versus revenue generated and if the cost of creating a Level IV Epilepsy center is justified. In the end, the use of a BSC will allow leadership to avoid overemphasizing any one aspect of the strategic plan and create a larger picture to help the plan achieve success (Huston, as cited in Laureate Education, 2013a).
Groene, O., Brandt, E., Schmidt, W., & Moeller, J. (2009). The balanced scorecard of acute settings: Development process, definition of 20 strategic objectives and implementation. International Journal for Quality in Healthcare, 21(4), 259-271. doi:10.1093/intqhc/mzp024
Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard – Measures that drive performance. Harvard Business Review, 70(1). Retrieved from
Kollberg, B., & Elg, M. (2011). The practice of the balanced scorecard in health care services. International Journal of Productivity and Performance Management, 60(5), 427-445. doi:10.1108/17410401111140374
Laureate Education (Producer). (2013a). The balanced scorecard approach[Video File]. Retrieved from
Sare, M. V., & Ogilivie, L. (2010). Strategic Planning for Nurses: Change Management in Health Care.Sudbury, MA: Jones and Ba