The balanced scorecard in health care: a multilevel latent variable approach

S-MEDUTA: Combining Balanced Scorecard with Simulation and MCDA Techniques for the Evaluation of the Strategic Performance of an Emergency Department

The scope of this paper is to propose a new integrated methodology for the evaluation of the strategic performance of a healthcare organization. In order to find the optimal strategy for an emergency department, we propose the combination of BSC, simulation, and UTASTAR algorithm. Through the simulation model, the stakeholders have the ability to evaluate the effect of their decisions on a number of KPIs that are important for the successful implementation of strategy on the ED. This method is able to provide a set of completed results (e.g., scores, weights, value functions, etc.), which may help the organization to evaluate and revise its strategy.

An e-healthcare system for disease prediction using hybrid data mining technique

Purpose

The purpose of this study is to alleviate the specified issues to a great extent. To promote patients’ health via early prediction of diseases, knowledge extraction using data mining approaches shows an integral part of e-health system. However, medical databases are highly imbalanced, voluminous, conflicting and complex in nature, and these can lead to erroneous diagnosis of diseases (i.e. detecting class-values of diseases). In literature, numerous standard disease decision support system (DDSS) have been proposed, but most of them are disease specific. Also, they usually suffer from several drawbacks like lack of understandability, incapability of operating rare cases, inefficiency in making quick and correct decision, etc.

Design/methodology/approach

Addressing the limitations of the existing systems, the present research introduces a two-step framework for designing a DDSS, in which the first step (data-level optimization) deals in identifying an optimal data-partition (Popt) for each disease data set and then the best training set for Popt in parallel manner. On the other hand, the second step explores a generic predictive model (integrating C4.5 and PRISM learners) over the discovered information for effective diagnosis of disease. The designed model is a generic one (i.e. not disease specific).

Findings

The empirical results (in terms of top three measures, namely, accuracy, true positive rate and false positive rate) obtained over 14 benchmark medical data sets (collected from https://archive.ics.uci.edu/ml) demonstrate that the hybrid model outperforms the base learners in almost all cases for initial diagnosis of the diseases. After all, the proposed DDSS may work as an e-doctor to detect diseases.

Originality/value

The model designed in this study is original, and the necessary parallelized methods are implemented in C on Cluster HPC machine (FUJITSU) with total 256 cores (under one Master node).

Two-way assessment of key performance indicators to vaccine supply chain system in India

Purpose

The purpose of this paper is to identify the key performance indicators (KPIs) of vaccine supply chain of Universal Immunization Program (UIP) India, and measure their impact on vaccine supply chain performance improvement, so that results of this study can help the decision makers manage the activity and effectiveness of their resources in order to improve vaccine delivery performance and child immunization coverage.

Design/methodology/approach

The 41 KPIs in terms of four dimension of the balanced scorecard (BSC), i.e. financial, customer, internal process and learning and growth have been identified and validated from the literature and expert’s opinions. Further, the impact of internal process and learning and growth performance indicators on the vaccine supply chain performance improvement have been evaluated using two-way assessment. The rankings obtained using two-way assessment are then compared to DEMATEL approach to validate the results.

Findings

The results from the analysis reveal that “Enhancement in employee work satisfaction” (LG3=10.08 percent), “Enhancement in professional vaccine supply chain managers and leaders” (LG2 = 6.70 percent) “Improvement in planning and coordination in the supply chain” (LG9 = 6.57 percent) are the three critical performance indicators having maximum impact on vaccine supply chain performance improvement. The decision makers should give priority to these performance indicators to improve delivery performance and immunization coverage.

Social implications

This study focuses on the improvement in vaccine delivery performance, therefore, analysis and findings can be useful to government immunization programs of India to other developing nations to improve child immunization coverage.

Originality/value

To our knowledge, this paper is first to attempt to provide a direction to improve immunization coverage through vaccine supply chain performance indicators.

Transportation costs do matter: simulation study from hospital investment decision

Purpose

Most OECD countries will have a considerable challenge ahead with an ageing population and necessary health care produced for retired people. Healthcare costs have increased continuously from the mid-1990’s in Finland, and growth is likely to continue in the future, as the amount of older inhabitants is increasing. Furthermore, transportation of patients and their visitors between homes and hospitals is a large component of the total health carehealth care related costs. This paper aims to estimate transport-related costs and develop ways to decrease these costs.

Design/methodology/approach

A system dynamics simulation model was developed to examine different scenarios for patients and their visitor transportation to hospitals until the year 2040. Model is driven by age distribution of the region and likely by development of the total population. All parameter values were defined based on real-life observations.

Findings

Patients’ need to travel to hospitals is likely to continue to grow. In addition, quality of travel will change as older retired people are not willing or able to use their own transportation equipment or public transportation modes – this is the main reason for higher transportation costs of patients. Transportation is typically conducted via taxis, private cars and ambulances. Therefore, it is critical that people from the region are able to access hospital services with short proximity.

Research limitations/implications

Simulation study is limited to one hospital investment decision in Finland. Distances and population densities as well as transportation mode alternatives differ from more populous regions in the world.

Practical implications

Research findings stressed the importance of keeping their own hospital operations within the region and placing them in a better location. In an alternative case, where a hospital decision would have been abandoned, total transportation costs during 2012-2040 would have increased by at least the same amount that a new hospital is assumed to cost.

Originality/value

This research is one of the first from the health care sector, where patient transportation modes and ageing is being dealt with in the context of new investments. Patient transportation is often an overlooked issue, which bears significant costs, especially as people age.

Applications of the balanced scorecard for strategic management and performance measurement in the health sector

In order to attain a useful balanced scorecard (BSC), appropriate performance perspectives and indicators are crucial to reflect all strategies of the organisation. The objectives of this survey were to give an insight regarding the situation of the BSC in the health sector over the past decade, and to afford a generic approach of the BSC development for health settings with specific focus on performance perspectives, performance indicators and BSC generation. After an extensive search based on publication date and research content, 29 articles published since 2002 were identified, categorised and analysed. Four critical attributes of each article were analysed, including BSC generation, performance perspectives, performance indicators and auxiliary tools. The results showed that 'internal business process' was the most notable BSC perspective as it was included in all reviewed articles. After investigating the literature, it was concluded that its comprehensiveness is the reason for the importance and high usage of this perspective. The findings showed that 12 cases out of 29 reviewed articles (41%) exceeded the maximum number of key performance indicators (KPI) suggested in a previous study. It was found that all 12 cases were large organisations with numerous departments (e.g. national health organisations). Such organisations require numerous KPI to cover all of their strategic objectives. It was recommended to utilise the cascaded BSC within such organisations to avoid complexity and difficulty in gathering, analysing and interpreting performance data. Meanwhile it requires more medical staff to contribute in BSC development, which will result in greater reliability of the BSC.