џWPC&/ ћџ2с“B ZеY/Yˆ Introduction Ton HoogenberkџџXXPhH  PX@FOOTER яU@У6GQќТЄ їU_2У=(2Уљ*2У_:t яU.УEћааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьќ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#б ааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ„ЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бHEADER яU@У6GQFЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УEћааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьќ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#б ааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ„ЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бћџ2э_Yr‘Ы ‘\ FOOTNOTE REF@У6GQbЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УEўааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ„м4Œ ф <”ьDœєLЄќ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#4є\  PP#бУУ ааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџм4Œ ф <”ьDœєLЄа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бФФFOOTNOTE TEX@У6GQpЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УEћааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ„м4Œ ф <”ьDœєLЄќ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#б ааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџм4Œ ф <”ьDœєLЄа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бHEADING 9 @У6GQ~Є їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УE! а ААА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ4` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  P єP#бУУзззз а ААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  P єP#бФФHEADING 8 @У6GQŒЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УE! а ААА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ4` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  P єP#бУУзззз а ААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  P єP#бФФћџ2‹‘ЙА ‘i ‘њHEADING 7 @У6GQšЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УE! а ААА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ4` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  P єP#бУУзззз а ААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бФФHEADING 6 @У6GQЈЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УEI а ААА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ4` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бггггггггУУзззз а ААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бФФHEADING 5 @У6GQЖЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УE ! а ААА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ4` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бУ Узззз а ААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бФ ФHEADING 4@У6GQФЄ їU_2 У=(2’ яUŒ Уљ*2У_:t яU.УE ! а ААмА аааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ` И hРpШ xа џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#XNє\  PXP#бУУзззз а мААА аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ,JЂњR Њ ZВ bКjТ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАмааб#єAє\  PєP#бФФћџ2ъ."Н0 пџџџџа ААœœ аа ААœœ агNLгг .,,. гааŸааа їЯ6С&A4џї аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџйБ‰a9  щ С™qI!љбЉY1! #с$Й&‘(i*A,.ё/Щ1Ё3y5Q7)9;й<Б>‰@aB9DFщGАœааЋXPhH  PX@(ШhH  Z ‹:Times New Roman StandaardXєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanє4є\  PPє\  `$Times NewRomanєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  P єPє\  `$Times NewRomanєєAє\  P єPє\  `$Times NewRomanєєAє\  P єPє\  `$Times NewRomanєєAє\  P єPє\  `$Times NewRomanєєAє\  P єPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєєAє\  PєPє\  `$Times NewRomanєXNє\  PXPє\  `$Times NewRomanXєAє\  PєPє\  `$Times NewRomanєМ[є\  PМPє\  `$Times NewRomanМXNє\  PXPє\  `$Times NewRomanXєChH  Pє@(ШhH  Z ‹:Times New Roman StandaardєXPhH  PX@(ШhH  Z ‹:Times New Roman StandaardXєAє\  PєPє\  `$Times NewRomanєXNє\  PXPє\  `$Times NewRomanXћџ2/$/3|xа œœm$ аааааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџœъ8 † д "pО ZЈіD М џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАœааааб#М[є\  PМP#бУ Уа€аperformance indicators in management practice:б#XNє\  PXP#бУУ a demonstration of a performance scoreboard in a teaching hospitalФФ ааа m$E+ аС““ССс с СС/ / СС}}!ССЫЫ%СС*ССgg/С ааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџF“с / }ЫgЕQŸэ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАEааааAbstract Ф ФУУRecent and reliable performanceЉinformation is the key to successful management in any organization. In the spring of 1994 Utrecht University Hospital, The Netherlands, decided to develop a scoreboard containing realЉtime information about a variety of keyЉperformance indicators. Today this information is available on every desktop computer throughout the hospital. This presentation describes the theoretical and technical background of the system, its birth and growth. It addresses the problems that arise while trying to translate an idea into a practical instrument. You will be shown the results as an interactive demonstration of a performance scoreboard that actually works and is used daily. ФФУ У г  гФ Фе&nа E+œœ агNLгг .,,. гааŸааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџйБ‰a9  щ С™qI!љбЉY1! #с$Й&‘(i*A,.ё/Щ1Ё3y5Q7)9;й<Б>‰@aB9DFщGАœааааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџй‰Fa9  щ С™qI!љбЉY1! #с$Й&‘(i*A,.ё/Щ1Ё3y5Q7)9;й<Б>‰@aB9DFщGџџАœааТ‰‰‰ТТFFFТ____________________________________________________________ТYYYТТ1!1!1!Тб#єChH  Pє@#б Т‰‰‰ТТFFFТAnja Bekink, У УPerformance indicators in mangement practiceФ Ф. Utrecht, September 1996б#XPhH  PX@#б&еУ Уг@-pag.-@га Ш аIntroductionФ Ф There is an increasing demand for upЉtoЉdate and reliable management-information. No competitive organization can do without. From a distance this should be a minor problem. Most organizations spent much time and effort to assemble as much data as they possibly can. Do all these data generate the information a manager longs for or does the manager run the risk of a daily overdose? The Utrecht University Hospital (UUH) believes that useful management information šmirrors the quality of the organization and its managers. Managent information systems should therefore present a clear and truthful picture of the daily operations. It šshould limit itself to information on coreЉprocesses; a manager should not be misled by the sheer limitless mountain of information that could be presented. Which data present key information about the successes and failures of the organization? It took more than two years of falling and scrambling to find the answers and compile them into a realЉtime performance scoreboard. У УBackgroundУУФ Ф a. The goals of UUHЉscoreboardФФ The executive board and the decentralized management teams of the hospital want to clarify and enhance the quality of performance information that passes between them. Reliability, simplicity and shared interpretation were important characteristics of the mission that was given to the project team, responsible for developing a performance scoreboard for the hospital. It should present a balanced image of reality. Studies of performance indicators stipulate that modern applications of performance indicators are mainly concerned with financial issues. They do not supply information on other performance areas, while consumers are increasingly service conscious and competition between institutions intensifies. In hospitals patients are well aware of the quality of the products they are offered. For patients and referring physicians, costumerЉorientation and service level are essential elements in selecting a hospital. Therefore, it is very important to have reliable information about perceived quality of patient care and services. A teaching hospital is also responsible for maintaining the quality of teaching and research and needs decent feedback on these issues. Conclusion: the Utrecht University Hospital decided to develop a scoreboard, with key indicators in four different performance РРdomainsРР в J EHH(EЇ Ї EHH(EЇ Ї J вмO„ O„ мммааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ„4Œ ф <”ьDœєLЄ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАEааУ УPortfolioФ Ф: what do we do?ммУ УCostsФ Ф: what does it cost? мO„  O„  мммУ УQualityФ Ф: What is the quality of our product?ммУ УServiceФ Ф: are we costumerЉoriented? мма œœŸ+ аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџF“с / }ЫgŸЕQŸэ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАEаа а Ÿ+E+ аааџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџF“с / }ЫgЕQŸэ!џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџАEааУУb. BuildingЉconditionsФФ The general performance of an institution is the compilation of the performance of all parts. It is important that the scoreboard clearly shows the overall picture but also who contributes to the general performance. Furthermore, it should be able to present performance data on every management level in a uniform format. УУc. UserЉorientation ФФ At the UUH information is gathered in the Hospital Information System, a simple name for several smaller independent systems . Hospital employees use these smaller systems to enter to the daily operational data. For instance: the outpatient clinic registers all data on patients, the contacts between patients and phycisians, the letters sent to the referring family doctors, the diagnosis and the proposed treatment. At the laboratories testЉdata from the same patients are registered. All these data are downloaded daily into a managementЉinformationЉserver. This server rearranges and reformats the data into uniform tables. Until a few months ago everybody processed the data in his or her own fashion which meant that much valuable time was wasted in doing identical jobs, with plenty of room for making mistakes. The UUHЉscoreboard supplies the manager with preconstructed information on key performance processes, on any given moment in time.ŒTo serve its purpose the scoreboard must be available, accessible and easy to interpret: It must show trends and direct indications of good or bad performance. Managers always seem to have timeЉproblems and do not have the necessary knowledge to operate the complex software. У УRealisation Ф Ф To transform a virtual key performance indicator into a usable instrument, the following steps are necessary: 1.Т“““ТPrepare a breakdown of the general idea into a detailed definition (uniformity of interpretation); 2.Т“““ТDetermine and retrieve the necessary data (registration method) 3.Т“““ТDesign a functional outline of the necessary software (determine the algorithms that transform data into kpiРРs) 4.Т“““ТDesign the technical outline of the necessary software (build the scoreboard) 5.Т“““ТCreate a helpЉfunction 6.Т“““ТCreate the organization that updates and validates the input. У У PitfallsФ Ф Setting up key performance indicators as a useful tool, is not without a hassle. The UUH scoreboard team encountered many problems. Problems concerning definitions and the sloppy registration of basic data. There were discussions with employees about the necessity of the system and the šthreats it holds for their yearly performance evaluations. Decent communication about the goals and content of the scoreboard, has proved to be essential for a successful implementation of this steering mechanism. У У Description of the demonstrationФ Ф. The performance scoreboard of Utrecht University Hospital is presented as a computer simulation. For about 45 minutes the audience will be in the seat of a UUHЉmanager and will see the organization through his/her eyes. Each performance indicator will be explained in terms of design and the problems that needed to be solved to implement it as a practical tool. During and after the demonstration there is room for discussion and additional šdemonstrations. У УExpected audience background, knowledge, experienceФ Ф Users and developers of management information systems, system managers and policymakers. No special knowledge or experience needed other than a keen interest in anaЌlysis, planning and management based on facts and figures. У УFurther ReadingФ Ф ааб#єAє\  PєP#бNadzam, D. M. et al, DataЉDriven Performance Improvement in Health Care: The joint commissionРРs indicator measurement system (IMSystem), 1993, УУThe Joint CommissionФФ, 11, 492 Љ 500 Linder J.C., Outcomes Maesurement in Hospitals; can the system change the organization?, 1992, УУHospital & Health Services AdministrationФФ, 37:2, 143 Љ 164 Iezzoni, L.I., L.G. Greenberg, Widespread Assessment of RiskЉAdjusted Outcomes; Lessons from local initiatives, 1994, УУJournal on Quality ImprovementФФ, 6, 305 Љ 310 Plsek, P.E., Advancing Process Improvement; Techniques for managing quality, 1995, УУHospital & Health Services AdministrationФФ, 40:1, 52 Љ 79 M.C.J. Smits, The Balanced Business Scorecard; bridge between vision and šperformance, 1993, УУ100 jaar de AccountantФФ, 4, 274 Љ 279 Herzlinger, R.E., Effective Oversight: a guide for nonprofit directors, 1994, УУHarvard Business ReviewФФ, julyЉaugust, 52 Љ 60. Harrington, H.J. Business Process Improvement; The breakthrough strategy for total quality, productivity and competitiveness, 1991, McGrawЉHill, Inc.б#XNє\  PXP#б