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Executive Summary
* Recognizing the pivotal role that emergency departments play in delivering care, forming first impressions, and driving operational flow, one organization utilized the balanced scorecard as a tool to focus on performance improvement.
* The balanced scorecard provides a framework for measuring internal business processes, customer perspectives, financial performance, and learning and growth.
* A multidisciplinary team selected the following measures on which to focus for the study period: laboratory test completion exceeding 30 minutes; laboratory specimen return rate; patient satisfaction; patient complaint rate; profit; staff satisfaction; and continuing education hours.
* All measures improved during the study period, albeit in varying degrees of statistical significance.
* In addition to selecting a careful array of measures, the implementation process of the measurement tool was accompanied by an educational process for the staff as well as a commitment to focus upon barriers and enablers to drive performance.
WITH THE INCREASING competition in health care markets, consumerism, and a series of cost-control policy changes implemented by the National Health Insurance plan in Taiwan, more hospitals are having difficulty maintaining their operations and are trying to find effective strategies to achieve their mission and to improve financial accountability. This is especially true for emergency departments (EDs) which have highly complex operational processes and deal with critical patients. Approximately 45% to 70% of hospitalized patients are admitted from the ED; therefore, the ED has become a primary revenue center for hospitals in Taiwan (Chou, 2002). However, because of long waiting times to see physicians, to obtain the results of laboratory tests, and to transfer to a ward, the EDs in Taiwan have become crowded and receive more patient complaints than other hospital units (Chern Sc Liaw, 2000). Moreover, patient satisfaction with services and whether a patient's requirements or expectations have been met are important factors in a patient's decision to return to a specific ED (Bruce, Bowman, & Brown, 1998; Schwab, 2000; Trout, Magmisson, & Hedges, 2002). Therefore, improving the quality of ED services and the patients' and their families' perceptions of those services are important to increasing the income and financial accountability of EDs.
Traditionally, finance has been the main quality indicator that a hospital used to measure any improvement in performance...