Keep one eye on the organization and one eye on the community: The next step in hospital balanced scorecards

In recent years, hospitals have implemented the balanced scorecard (BSC) for performance assessment and it is now common in the hospital industry. Scorecards give internal stakeholders (and to a lesser extent external stakeholders) critical information about a hospital's performance. Scorecards create a mostly internal view of hospital performance by reporting four categories of indicators: financial, customer satisfaction, business processes, and, learning/growth. Current hospital management literature and health administration education programs emphasize that health organizations (including hospitals) must work to improve community health and the health status of their local populations. Healthcare management is shifting from emphasis on acute inpatient care, treating illness, and responsibility for individual patients toward more emphasis on the continuum of care, maintaining wellness, and responsibility for health of a population. Many hospitals' mission statements and long range goals include improving health of the local population, and hospitals have become active in community health. However, this is not yet reflected in hospitals' BSCs that are internally focused. The next step in hospital BSCs should be to include indicators for community health status. This session briefly reviews the evolution of hospital BSCs to show why they are internally focused. The session explains how BSCs should expand to include hospital performance pertaining to community health status. That approach would support hospitals, communities, and public health. Proposed health status measures (based on community health assessment indicators) are suggested along with data sources and methods. The session concludes with implications and future directions.