In London, some interesting news broke last week. The Department of Health hired McKinsey to draw up Balanced Scorecards for their Primary Care Trusts. The PCTs are the providers of primary healthcare in a centralized healthcare system like the UK. So of course the PCTs are not happy about it, but it does raise the question about whether a third party can build a scorecard for your organization.

According to Wikipedia, each trust has their own budget and sets their own priorities. I guess I can infer that means a PCT could have a different strategy based on the local or regional conditions (read health population). So, it is not surprising that the local PCTs are not happy about McKinsey building a scorecard for them.

Steve Nowottny at Pulse writes "McKinsey has been asked to help draw together existing information to develop 85 different quality indicators." OK, first, this must not be a Norton-Kaplan Balanced Scorecard. The Norton-Kaplan model focuses an organization on the 15-25 measures that reflect the strategy of the organization. Further, based on the strategy, an organization may have to develop new measures. Just choosing existing measures may create a bit of a problem. Nowottney quotes Dr. Richard Vautrey as saying "just because something can be measured doesn't necessarily mean it's a useful tool as an indicator." Three cheers to that. I couldn't agree more.

So at first blush, a third party is being asked to draw up 85 measures from existing data to represent quality and performance across a variety of PCTs, which may have different strategies. It sounds terrible.

If I had the power to guide the DHS on how to best use this exercise, I would recommend a few tweaks to the system. First, I would recommend using these measures as a template for PCTs. I would declare a small subset necessary for benchmarking across the DHS. I would make sure these measures were per capita oriented, and based on the population of doctors or patients depending on the measure. I would also give flexibility to the PCTs to declare their strategy and modify the scorecards to meet their needs. I would involve the leaders in the process and listen and learn from them what they think is the most effective indicator of performance in their organization.

Finally, I would work with the PCT leadership to demonstrate the value of a Balanced Scorecard to the individual PCT as well as to the DHS. In healthcare especially, spending money on anything but patient care is frowned upon, unless value can be demonstrated. Balanced Scorecards have proven to provide a tremendous amount of value in the healthcare field, if applied correctly. The doctors and managers need to be shown and proven the value.