Balanced Scorecards as a Tool for Developing Patient-Centered Pharmacy Services

Abstract

H ospitals and health systems are required to measure and track performance due to government, private, and consumer pressures to ensure quality health care services. Hospital valuebased purchasing (HVBP) programs, meaningful use incentives, and the Patient Protection and Affordable Care Act (ACA) are examples of programs that force accountability and quality of care while reducing overall health care expenditure.1 Pharmacy directors face signifi cant challenges with rising drug costs and limited pharmacy staff while being expected to provide the highest quality pharmacy services. To meet these expectations, the pharmacy director must balance resources and performance. They must show how they have achieved that balance. Essential department data can be effectively used to help measure the success of the department in meeting their strategic goals, which are ideally aligned with the organization's priorities. 2Balanced scorecards (BSCs) are used in health care to list the results of the delivery of health care services as a continuous quality improvement approach.3 The BSC was fi rst introduced in 1992 byKaplan and Norton as a way to view performance broadly rather than a narrow focus on fi nancial measures. 4,5 The BSC contains 4 perspectives: customer, internal process, innovation and learning, and fi nancial. The BSC was fi rst discussed as a tool to be used in health-system pharmacy as a way to demonstrate pharmacy's value in meeting its key performance metrics. 6 In addition, BSCs were introduced in 1999 to improve medication use and to manage resources devoted to drug therapy. 7 The BSC is often divided into sections that refl ect the key operations of a pharmacy department, including medication safety, operations, quality, fi nance, education, and research.The terms BSCs and dashboards are often used interchangeably, but these tools are distinctly different. BSCs trend performance metrics over longer time intervals of weeks, months, and quarters; dashboards, track performance over shorter intervals in minutes, hours, and days. Dashboards typically serve as tactical indicators on the state of a process and focus on action limits involving trend lines instead of progress toward prespecifi ed goals. A BSC is often structured to measure organizational performance Having accurate data is essential for the pharmacy director to manage the department and develop patient-centered pharmacy services. A balanced scorecard (BSC) of essential department data, which is a broad view of a department's function beyond its fi nancial performance, is an important part of any department's strategic plan. This column describes how the pharmacy director builds and promotes a department's BSC. Specifi cally, this article reviews how the BSC supports the department's mission and vision, describes the metrics of the BSC and how they are collected, and recommends how the pharmacy director can effectively use the scorecard results in promoting the pharmacy. If designed properly and updated consistently, a BSC can present a broad view...

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