From Direction to Deliverables: An Action Plan and Balanced Scorecard for a Community Hospital's Academic Affiliation
Student Name
Master of Science in Nursing Program, Aspen University
N547: Health Care Strategic Management and Planning
Instructor Name
Month Day, Year
From Direction to Deliverables: An Action Plan and Balanced Scorecard for a Community Hospital's Academic Affiliation
In the previous module, the composite independent hospital's leadership chose to partner with a university teaching hospital, without merging, as its strategic direction, in preference to remaining fully independent or merging into a regional system. A direction is not yet a plan. This paper translates the affiliation strategy into an action plan, with objectives, accountable owners, timelines and resources, and into a balanced scorecard that will show within months whether the strategy is working. It also explains why each measure was chosen and how the scorecard will be used.
From Strategy to Objectives
Ginter et al. (2018) describe the planning stage as moving from directional strategies to adaptive strategies and then to action plans that name who will do what, by when and with which resources. The affiliation strategy has three purposes identified in earlier analyses: to strengthen the nursing workforce, to draw patients to the hospital's primary care offices by shortening their path to specialists, and to address the community's leading health needs, particularly diabetes and heart failure. Five objectives follow from those purposes, each written so that its completion can be verified.
| Objective | Owner | Deadline | Resources |
|---|---|---|---|
| 1. Sign an affiliation agreement covering telemedicine specialty coverage, shared protocols and joint nurse recruitment | Chief executive officer with the board | Month 4 | Legal review, $60,000 |
| 2. Launch telemedicine coverage in neurology and endocrinology, reducing avoidable transfers | Chief medical officer | Month 9 | Equipment and fees, $220,000 a year |
| 3. Open a joint nurse residency with the academic center, 24 new graduates a year | Chief nursing officer | Month 10 | Educator and preceptor time, $310,000 a year |
| 4. Build a diabetes and heart failure program linking primary care offices, hospital specialists and home follow-up | Vice president of ambulatory services with nursing | Month 12 | Two nurse care managers, $250,000 a year |
| 5. Agree a joint capital planning process and review triggers for the relationship | Chief financial officer | Month 6 | Staff time |
Why a Balanced Scorecard
A strategy that is measured only by financial results tends to be judged too late, because finances reflect decisions made months or years earlier. The balanced scorecard, introduced by Kaplan and Norton (1992), places financial measures alongside three other perspectives, the customer, internal business processes, and learning and growth, which lead financial results rather than follow them. The evidence in health care is encouraging but not strong. A systematic review of 20 studies found positive effects of scorecard implementation on patient satisfaction and financial performance and a milder effect on staff satisfaction, while noting that many of the studies carried a high risk of bias (Amer et al., 2022). The scorecard is therefore adopted here as a management discipline for linking measures to strategy, not as a guarantee of results.
For a nonprofit hospital, the customer perspective is best framed as the patient and community perspective, and the learning and growth perspective is where nursing workforce measures belong, since the workforce is the resource the strategy most depends on.
The Scorecard
The scorecard contains three measures in each perspective, with the current baseline and the target for the end of the second year.
| Perspective | Measure | Baseline | Target, year 2 |
|---|---|---|---|
| Financial | Operating margin | 1.0% | 2.5% |
| Financial | Contract labor spending as a share of nursing labor cost | 7% | 3% |
| Financial | Commercially insured outpatient visits, change from prior year | -4% | +2% |
| Patient and community | Transfers to other hospitals for neurology or endocrinology conditions | 310 a year | 200 a year |
| Patient and community | Patients with diabetes in the program with A1c above 9% | 28% | 20% |
| Patient and community | Heart failure 30-day readmission rate | 21% | 17% |
| Internal process | Share of primary care referrals to hospital specialists completed within 14 days | 55% | 80% |
| Internal process | Telemedicine consults completed within 60 minutes of request | Not measured | 90% |
| Internal process | Patients with heart failure contacted within 72 hours of discharge | 40% | 85% |
| Learning and growth | Registered nurse first-year turnover | 24% | 12% |
| Learning and growth | Registered nurse vacancy rate | 6% | 4% |
| Learning and growth | Nurses with specialty certification | 41% | 45% |
How the Measures Connect
The measures are chosen to form a chain from the learning and growth perspective to the financial one. A joint nurse residency should reduce first-year turnover and vacancies, which lowers reliance on contract labor, the second financial measure. The diabetes and heart failure program, staffed by nurse care managers, should improve the process measures on referral timeliness and post-discharge contact, which in turn should lower readmissions and improve glucose control. Telemedicine coverage should reduce transfers, keeping patients and their revenue in the community. If the leading measures move and the financial measures do not, the chain is broken somewhere, and the scorecard shows where to look.
Using the Scorecard
Every quarter the executive team, and twice a year the board, will go through the scorecard, with each measure's owner reporting on progress and on the reasons for any shortfall. The chief nursing officer will present the learning and growth perspective, which gives nursing a standing voice in the strategy's review. Targets will not be changed during the year to make results look better; if a target proves unrealistic, the reason will be documented and the change approved by the board. The first formal review of whether the affiliation is delivering, and whether the triggers set in the previous module have been reached, will take place at the end of the first year.
Conclusion
The affiliation strategy becomes real only when it is broken into objectives with owners, dates and resources, and when leaders can see early whether it is working. The action plan sets five objectives, from signing the agreement to launching a nurse residency and a chronic disease program, and the balanced scorecard tracks twelve measures that link the nursing workforce to patient outcomes and finances. The evidence for scorecards in health care is positive but imperfect, which is a reason to use this one as a disciplined conversation about strategy, one in which nursing measures sit at the base of the chain.
References
Amer, F., Hammoud, S., Khatatbeh, H., Lohner, S., Boncz, I., & Endrei, D. (2022). The deployment of balanced scorecard in health care organizations: Is it beneficial? A systematic review. BMC Health Services Research, 22(1), Article 65. https://doi.org/10.1186/s12913-021-07452-7
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care organizations (8th ed.). Wiley.
Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review, 70(1), 71-79.
How this N 547 Module 6 example is structured
Aspen does not publish N547 module prompts, so check your classroom for the exact instructions and template. This example restates the chosen strategy, derives five objectives in a table with owners, deadlines and resources, explains the balanced scorecard and its health care evidence, presents twelve measures with baselines and targets, explains the causal chain between them, and sets out how the scorecard will be reviewed.
N547 Module 6 questions, answered
What does N547 Module 6 usually ask for?
After a strategy is chosen, N547 typically asks for a documented plan of action, often with a way to measure progress such as a balanced scorecard. Check your classroom for the required format and number of measures.
What are the four perspectives of a balanced scorecard?
Financial, customer, internal process, and learning and growth. Health care organizations often rename the customer perspective as patient and community and place workforce measures under learning and growth.
What makes an action plan objective strong?
A verifiable outcome, one accountable owner, a deadline and the resources needed. Objectives shared by several owners or without dates are the most common reason plans stall.
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