[The balanced scorecard--applications in a radiology department]

Development of a balanced scorecard as a strategic performance measurement system for clinical radiology as a cost center

Objectives

To develop a goal-oriented indicator system based on the balanced scorecard (BSC) concept, which takes into account the perspectives of the referring physician and patient and emphasizes the focus on the internal processes of the radiology department.

Methods

Development of a BSC occurred in six steps: (Step 1) strengths/weaknesses and opportunities/risks (SWOT-) analysis of the radiology department, (Step 2) setting-specific objectives (model, core values, key objective) followed by the development of 4 perspectives, (Step 3) and definition of strategic issues oriented to the value-added chain of the processes of the radiology department. (Step 4) Creation of a “Strategy Map” with regard to the perspective and their cause–effect relationships. (Step 5) Development of an automated key performance indicator (KPI) cockpit for the monitoring, reporting, and management scorecard.

Results

A total of 10 success factors were identified using SWOT analysis. The core values include high quality in clinical, teaching, and research areas. The radiological value-added chain is composed of three processing steps. 1. registration, 2. examination, and 3. reading/X-ray demonstration. Three action programs were derived: 1. increase competency (e.g., specialist standard), 2. improve referring physician/patient satisfaction, 3. increase productivity. Daily process monitoring was added to the management cockpit as a monitoring scorecard. The scorecard comprises 18 KPIs and is automatically updated every month. The annual management scorecard comprises 10 KPIs.

Conclusions

The BSC makes it possible to implement a strategy for radiology that is strongly oriented toward the requirements of the referring physicians and the demands of patients.

[Business intelligence in radiology. Challenges and opportunities]

Due to economic pressures and need for higher transparency, a ubiquitous availability of administrative information is needed. Therefore radiology managers should consider implementing business intelligence (BI) solutions. BI is defined as a systemic approach to support decision-making in business administration. It is an important part of the overall strategy of an organization. Implementation and operation is initially associated with costs and for a successful launch important prerequisites must be fulfilled. First, a suitable product must be selected, followed by the technical and organizational implementation. After consideration of the type of data to be collected and a system of key performance indicators must be established. BI replaces classic retrospective business reporting with multidimensional and multifactorial analyses, real-time monitoring, and predictive analyses. The benefits of BI include the rapid availability of important information and the depth of possible data analysis. The simple and intuitive use of modern BI applications by the users themselves (!) combined with a continuous availability of information is the key to success. Professional BI will be an important part of management in radiology in the future.

[Health technology assessment (HTA). Developments in healthcare and potential for radiology]

CLINICAL/METHODICAL ISSUE

Cost-intensive measures and procedures, such as also employed in radiology, have far-reaching economic implications in respect to increasing expenditure with limited resources.

STANDARD RADIOLOGICAL METHODS

Health technology assessment (HTA) describes the systematic evaluation of medical procedures and technologies which in recent years has been introduced by many countries into healthcare politics.

ASSESSMENT

In many cases HTA analyses can be directly implemented into practice as shown by the examples given in this article; however, in the current form of HTA the practical implementation for radiology often presents the problem that the cost-benefit ratio does not yet have a comprehensive view in the HTA report but is limited to a subsection, e.g. current costs versus sensitivity of a method. Since its inception radiology has had a high power of innovation and new developments will also substantially determine the future years. These procedures must not only be evaluated with respect to feasibility but also in the sense of the HTA in the total concept.

PRACTICAL RECOMMENDATIONS

In radiology there are also a large number of possibilities for radiologists not only as passive consumers of HTA reports but also to become active participants in this process, an opportunity which should be taken advantage of.