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Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us (2014)

Chapter:Appendix C: Performance Measure Framework and Balanced Scorecard Example

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Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
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Appendix C


Performance Measure Framework
and Balanced Scorecard Example

Throughout this report, the committee recognizes the need for the Department of Homeland Security (DHS) to take a strategic approach to planning for and management of workforce health protection. An important part of strategic planning is aligning activities with the department’s vision and strategy and ensuring the ability to monitor progress and adjust accordingly based on predetermined measures and metrics. Although the committee recognizes that there are multiple approaches DHS can take to these ends, this appendix provides as an example the performance measure framework and balanced scorecard currently used by the U.S. Coast Guard1 for tracking progress on strategic goals and objectives and for accountability purposes. Ultimately, the committee believes DHS will be in the best position to determine which approach to take and what metrics to use.

__________________

1USCG (U.S. Coast Guard). 2011. Office of health services strategic plan (2011-2015). Washington, DC: USCG.

Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
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Performance Measure Framework

Measurement Focus

In light of these major initiatives the following information is intended to provide a framework to monitor success as this Strategic Plan is carried out, enabling value creation opportunities and building momentum toward organizational excellence. Notes are provided in parenthesis (red text) below to link them with existing measure in the Balanced Scorecard.

Quad Aim Strategic Imperative Performance Measure(s) Initiatives
Medical Readiness Individual Medical Readiness

Family Readiness
Readiness compliance (S1 measure)

EHR Utilization

Work-Life Survey

•   Reserve Health Readiness Program (RHRP) for Periodic Health Assessment & Dental Screening for Reservists (S1 measure)

•   Track/identify deployment limiting conditions (S1 measure)

•   Patient Centered Medical Home Implementation (SG 3 measure)

•   Epic Electronic Health Record Implementation (SG 1,3,4,5 measures)

•   Work-Life Family Readiness programs

Healthy workforce (Psychological) Identify % completed of post deployment health medical needs

•   Conduct/track Pre and post deployment assessments (PDHA, PDHRA) (S2 measure)

•   Others to be developed

•   Operational Stress Continuum adoption (SG 1 measure)

Population Health Engaging workforce in healthy behaviors Influenza management

Adopt HEDIS measures

Percentage of population over fat

•   Maintain influenza prevention program (S1 measure)

•   Monitor tobacco use

•   Monitor weight program

•   Integrate health lifestyle program

•   HEDIS Women's health measures

•   Identify and prepare for other emerging health threats

•   Implement Population Health Portal access (IP 5 measure)

•   Quad Aim/PCMH - Population Health (SG 1 measure)

Experience of Care Evidence-based care

24/7 access to your team (C2 measure)
Enrollee Preventive Health metric

HEDIS Index

Internal/external EPIC/MRRS

Number of referrals by clinic provider (F1 measure)

External Accreditation (C3 measure)

•   Develop system wide policy for access to Medical Home

•   Effective Appointment template Management (F1 measure)

•   Monitor Medical Home initiative

•   Identify elements of patient behavior, e.g. primary & specialty care visits per member per year

•   Adopt NCQA Certification of Medical Home (tentative)

Case Management

Personal relationship with your provider
Effectiveness of care for complex Med/Social problems

Satisfaction with health care (C1 measure)

•   Continue Patient Satisfaction Survey and Peer Review; medical Encounter Review System (MERS) (S3, C1, IP3 measures)

•   Implement Medical Home

•   Continue HSWL SC Case Management Program

Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
Strategic Imperative Performance Measure(s) Initiatives
Per Capita Cost (Responsible Stewardship) Optimize all product lines by using standard business planning processes CG-11/HSWL Budget Execution/Performances

Enrollment utilization of ER services

Reduce PMPM costs for healthcare

Identify provider excess capacity for reallocation of responsibilities

•   Approval of clinic business plan submission

•   Maximize opportunities to identify and implement solutions that gain efficiency

•   Develop/implement staffing standard (R3 measure)

•   Ensure AFC-57 FRMM Compliance (R1 measure)

•   Adhere to AFC-57 Budget Model

CFO Act compliance Achieve Audit Compliance in Financial Processes (F2 measure)

•   Complete Electronic billing MOU with DoD

•   Achieve MERHCF billing (F1 measure)

•   Achieve OHI Billing Capability (F1 measure)

•   Resolve weaknesses identified within DoD MTF claims processing

•   Identify and counter internal weaknesses in business processes (F2 measure)

Learning & Growing Functional EHR Implementation of CG EHR (IP7 measure)

Provider satisfaction with EHR

•   Sustain EHR

•   Maintain HIPAA Compliace

•   Conduct MIS Program Review Board

•   Enhance Coding Accuracy

•   Conduct periodic Staff Satisfaction surveys

Using research to improve performance Product and Product Services

•   Implement an in-house IRB

Fully capable CG workforce Complete EHR Training

•   Monitor training database (IP4 measure)

•   Track organizational competency development

•   Complete Health Service Corps Analysis

•   Identify IT enhancements to support provider effectiveness

•   Improve deployment capability for contingency response

•   Add professional training courses

Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×

Balanced Scorecard

Balanced Scorecard

The balanced scorecard is a strategic planning and management tool that is used to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organization performance against strategic goals. The balanced scorecard suggests that we view the organization from four perspectives, and to develop metrics, collect data and analyze it relative to each of these perspectives:

The Learning & Growth Perspective

This perspective includes employee training and corporate cultural attitudes related to both individual and corporate self-improvement. In a knowledge-worker organization, people -- the only repository of knowledge -- are the main resource. In the current climate of rapid technological change, it is becoming necessary for workers to be in a continuous learning mode. Learning and growth constitute the essential foundation for success of any knowledge-worker organization.

The Business Process Perspective

This perspective refers to internal business processes. Metrics based on this perspective allow us to know how well the business activities are running, and whether our products and services conform to customer requirements (the mission).

The Customer Perspective

Recent management philosophy has shown an increasing realization of the importance of customer focus and customer satisfaction in any business. These are leading indicators: if customers are not satisfied, they will eventually find other suppliers that will meet their needs. Our healthcare delivery system must adhere to the same principles to satisfy beneficiaries and to develop processes that are efficient and effective.

The Financial Perspective

Timely and accurate funding data will always be a priority, and we must do whatever is necessary to provide it. With the implementation of the Epic® Electronic Medical Record, standardized business planning and other initiatives, it is hoped that more of the processing can be centralized and where possible automated. There is a major organizational emphasis on financials to maintain the ability to meet operational mission requirements. There is a need to include additional financial-related data, such as risk assessment and cost-benefit data, in this category

The following two sections seek to: (1) provide some clarity on measures being developed and how the intersect with the Balanced Scorecard perspectives, and (2) provide a visual Strategy Map to help illustrate how our activities are influenced within the perspectives.

Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×

Measures of Primary Emphasis

Balanced Scorecard Perspectives Strategic Goal 1 Provide for a Medically Ready & Protected Coast Guard Active Duty & Reserve Member Workforce Strategic Goal 2 Maintain & develop an operational response capability & operationally ready Coast Guard Medical Force Strategic Goal 3 Provide quality, accessible & efficient care Strategic Goal 4 Create Chief Financial Officer (CFO) compliant Coast Guard Health Care Financial Management System and an overall increased emphasis on business planning for the Coast Guard’s Organic Health Care Delivery System Strategic Goal 5 Achieve full operational capability & modernization of Coast Guard Mission Support
Customer Perspectives Readiness Compliance

Internal/external EPIC/MRRS

Percentage of population over fat
Deploy with CG and DoD assets in training environments Satisfaction with health care

Number of referrals by clinic provider
Staffing Standard Patient Centered Medical Home implementation
Internal Process Perspective Post deployment health medical needs

Enrollee Preventive Health metric

MRRS/CGBI data feeds, monitoring, and communication
Track and manage CG/DoD deployments to ensure breadth of knowledge across the organization Work-Life Survey

Effectiveness of care for complex Med/Social problems

HEDIS Index

Adopt HEDIS measures

HSWL SC HPAP surveys
External Accreditation (AAAHC/NCQA)

Internal QA process (HPAP)

Regional Practice Business Planning Process/Budget Build
Influenza management

PCMH/EHR

Maintain achieved gains of HSWL SC implementation

Leverage regional practice concept for accountability, communication, standardization
Learning and Growth EHR Utilization PCMH implementation training Implementation of CG EHR Complete EHR Training Develop Training tracking database and proactively manage training quotas Provider satisfaction with EHR Tracking and reconciliation of training quotas Tracking/optimizing utilization of training quotas HSWL FO Guide/Org Man
Financial Perspective Prioritize funding to Readiness programs for ensured continuity Dedicate deployment/training quotas targeting operational experiences Enrollment utilization of ER services Achieve Audit Compliance in Financial Processes CG-11/HSWL Budget Execution/Performances
Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×

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Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
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Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
Page300
Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
Page301
Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
Page302
Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
Page303
Suggested Citation:"Appendix C: Performance Measure Framework and Balanced Scorecard Example." Institute of Medicine. 2014. Advancing Workforce Health at the Department of Homeland Security: Protecting Those Who Protect Us. Washington, DC: The National Academies Press. doi: 10.17226/18574.
×
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The more than 200,000 men and women that make up the Department of Homeland Security (DHS) workforce have been entrusted with the ultimate responsibility - ensuring that the homeland is safe, secure, and resilient against terrorism and other hazards. Every day, these dedicated individuals take on the critical and often dangerous challenges of the DHS mission: countering terrorism and enhancing national security, securing and managing the nation's borders, enforcing and administering U.S. immigration laws, protecting cyber networks and critical infrastructure, and ensuring resilience in the face of disasters. In return, DHS is responsible for protecting the health, safety, and resilience of those on whom it relies to achieve this mission, as well as ensuring effective management of the medical needs of persons who, in the course of mission execution, come into DHS care or custody.

Since its creation in 2002, DHS has been aggressively addressing the management challenges of integrating seven core operating component agencies and 18 supporting offices and directorates. One of those challenges is creating and sustaining a coordinated health protection infrastructure. Advancing Workforce Health at the Department of Homeland Security examines how to strengthen mission readiness while better meeting the health needs of the DHS workforce. This report reviews and assesses the agency's current occupational health and operational medicine infrastructure and, based on models and best practices from within and outside DHS, provides recommendations for achieving an integrated, DHS-wide health protection infrastructure with the necessary centralized oversight authority.

Protecting the homeland is physically and mentally demanding and entails many inherent risks, necessitating a DHS workforce that is mission ready. Among other things, mission readiness depends on (1) a workforce that is medically ready (free of health-related conditions that impede the ability to participate fully in operations and achieve mission goals), and (2) the capability, through an operational medicine program, to provide medical support for the workforce and others who come under the protection or control of DHS during routine, planned, and contingency operations. The recommendations of this report will assist DHS in meeting these two requirements through implementation an overarching workforce health protection strategy encompassing occupational health and operational medicine functions that serve to promote, protect, and restore the physical and mental well-being of the workforce.

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