title: The Balanced Scorecard of acute settings: development process, definition of 20 strategic objectives and implementation.
abstract: BACKGROUND
  Strategy development and implementation in acute care settings is often restricted by competing challenges, the pace of policy reform and the existence of parallel hierarchies.
  
  
  OBJECTIVE
  To describe a generic approach to strategy development, illustrate the use of the Balanced Scorecard as a tool to facilitate strategy implementation and demonstrate how to break down strategic goals into measurable elements.
  
  
  METHODS
  Multi-method approach using three different conceptual models: Health Promoting Hospitals Standards and Strategies, the European Foundation for Quality Management (EFQM) Model and the Balanced Scorecard. A bundle of qualitative and quantitative methods were used including in-depth interviews, standardized organization-wide surveys on organizational values, staff satisfaction and patient experience.
  
  
  METHODS
  Three acute care hospitals in four different locations belonging to a German holding group.
  
  
  METHODS
  Chief executive officer, senior medical officers, working group leaders and hospital staff.
  
  
  METHODS
  Development and implementation of the Balanced Scorecard.
  
  
  METHODS
  Twenty strategic objectives with corresponding Balanced Scorecard measures.
  
  
  RESULTS
  A stepped approach from strategy development to implementation is presented to identify key themes for strategy development, drafting a strategy map and developing strategic objectives and measures.
  
  
  CONCLUSIONS
  The Balanced Scorecard, in combination with the EFQM model, is a useful tool to guide strategy development and implementation in health care organizations. As for other quality improvement and management tools not specifically developed for health care organizations, some adaptations are required to improve acceptability among professionals. The step-wise approach of strategy development and implementation presented here may support similar processes in comparable organizations.
authors: Avedis Donabedian Research Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health, Barcelona, Spain. ogroene@fadq.org
authors: Oliver
authors: O
authors: Groene
authors: Elimer
authors: E
authors: Brandt
authors: Werner
authors: W
authors: Schmidt
authors: Johannes
authors: J
authors: Moeller
mesh_terms: D006293:Health Promotion / Q000458:organization & administration; D006739:Hospital Administration / Q000379:methods*; D006801:Humans; D009937:Organizational Objectives; D010358:Patient Participation; D017060:Patient Satisfaction; D016730:Program Development / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*