Presented at 2006 Healthcare Conference at Thailand

1. Applying Balanced Scorecard A Zulekha Hospital Case study Dr Kishan Pakkal Director -Operations & Gururaj Rai ,MHA Business Development Manager Presented in Thailand 2006 –Healthcare Conference

2. Today’s Presentation Zulekha Healthcare Group Overview Beginnings, evolution of BSC process A new era of accountability To Judge the results

3. Dubai

4. UAE

5. Zulekha Healthcare Group Overview Hospitals • Zulekha Hospital – Sharjah – 60 beds • Zulekha Hospital – Dubai - 75 beds Medical Centres• Zulekha Medical Centre - Qusais, Dubai• Zulekha Medical Centre - Al Wahda, Sharjah• Zulekha Medical Centre - Dhaid, SharjahPharmacies• Pharmacy - Al Rafea, Qusais, Dubai• Pharmacy - Zulekha Hospital, Sharjah• Pharmacy - Zulekha Hospital, Dubai

6. Overview of Zulekha Hospital’s care program Popular Healthcare units at Dubai and Sharjah Notable specialty departments – Gynaec and Laparoscopy, Invasive Cardiology, Orthopedics and Knee replacement ISO Certification and currently in line with JCI accreditation.

7. Strategic Planning so far As an healthcare provider we are striving for Quality Care through International accreditations

8. Resulted In…. A very comprehensive plan being developed Too many Indicators, Contained no real accountability Anyone who had an idea got their item in the plan Indicators linked to performance and not to strategy

9. Other factors Changes in the external Healthcare environment, such as the Healthcare Quality drive by Health Authority

10. Initial Progress Progress Began tracking Hospital performance on various deployed quality indicators. Pitfalls Functioned primarily as a kind of isolated meter, with no connectivity of the measures. Rather than a new way of running the Hospital, It was one more thing to do every month

11. The Problem.. We were trying to work with a performance measurement tool in advance of crafting a focused business strategy.

12. A New Approach Taken Decision was made to take a different approach to strategy development. We viewed ourselves as a business and identified our margin, market opportunities, which shaped the financial dimension of our strategy map. This increased margin opportunity would then allow us to reinvest in the non-growth areas of the organisation

13. Pilot study has been deployed by implementing Balanced Score Card on Radiology Department to study its efficacy

14. Balanced Score Card

15. Balanced score card Balanced Scorecard is simply a concise report featuring a set of measures that relate to the performance of an organization. BSC gives management a framework or language which would communicate the organisation's mission and strategy, while using measurement to inspire employees to achieve specified outcomes.

16. Imagine flying a Boeing just with one meter – it would be disastrous. BSC advocates the same philosophy, that Organization should be looked beyond Financial meter.

17. It focuses not only on financial areas that were of significant importance traditionally but also on Internal process, customer and learning and growth

19. The Balanced Score Card Mantra Organizatons should clearly communicate their vision and strategy to all levels of the management and look at critical success measures to achieve the goal. Real success just not depends on achieving financial goals.

20. How did we apply Balanced score Card ??

21. First, understanding our Customers Value propositions to provide clarity in strategy BASIC CARE PATIENTS SPECIALITY CARE PATIENTS INSURANCE CO. CORPORATES CUSTOMER INTIMACY BRAND & TECHNOLOGY LEADERSHIP OPERATIONAL EXCELLENCE

22. Hospital viewed as a business unitBalanced Score Card Approach Vision: To be the most efficient, competent and courteous providers of comprehensive healthcare in the world.” Mission : “To provide easy accessibility to high quality healthcare” FINANCIAL To financially sustain our Mission, on what must we focus ? CUSTOMER To achieve our Vision, how should we appear to our customers? INTERNAL To satisfy our customers at which operational processes must we excel ? LEARNING & GROWTH How will we sustain our ability to change and improve ?

23. Strategy Map - Objectives Build a strong Financial Base to implement the GROWTH strategy of the Hospital Market opportunities Deliver Cost Efficient Care FINANCIAL To financially sustain our Mission, on what must we focus ? Basic Care Patients Specialty Care Patients Referring Physicians Insurance Co. CUSTOMER To achieve our Vision, how should we appear to our customers? Provide Outstanding Customer Service Clinical Excellence Strive for Operational Excellence INTERNAL To satisfy our customers at which operational processes must we excel ? Instill a climate for change Implement Technology Skill and Competency Development LEARNING & GROWTH How will we sustain our ability to change and improve ?

24. Strategy Map - Measures Build a strong Financial Base to implement the GROWTH strategy of the Hospital MarketOpportunities FINANCIAL Excellent service and Personal relationships Leading technology Low cost service and Innovative Programs Leading edge expertise CUSTOMER EasyAccess On Time Service Research & Clinical practice mgmt Maximize Staff efficiency INTERNAL Involvement & commitment to the mission Implement technology to support internal process Develop critical staffing resource plans Develop a Quality Mindset LEARNING & GROWTH

25. Corporate level Strategy Map Vision: To be the most efficient, competent and courteous providers of comprehensive healthcare in the world.” Build a strong Financial Base to implement the GROWTH strategy of the Hospital Growth Deliver Cost Efficient Care Market Opportunities FINANCIAL Basic Care Patients Specialty Care Patients Referring Physicians Insurance Co. Excellent service and Personal relationships Low cost service and Innovative Programs Leading technology Leading edge expertise CUSTOMER Provide Outstanding Customer Service Strive for Operational Excellence Develop Clinical Excellence Easy Access On Time Service Research & Clinical practice mgmt Maximize Staff efficiency INTERNAL Instill a climate for change Implement Technology Skill and Competency Development Involvement & commitment to the mission Implement technology to support internal process Develop critical staffing resource plans Develop a Quality Mindset LEARNING & GROWTH

26. Balanced Score Card Initiatives Objectives Measures Initiatives Targets Financial Deliver Cost Efficient Care Excellent service and Personal relationships Customer Leadingtechnology Leadingedgeexpertise Low cost service and Innovative Programs

27. Balanced Score Card Initiatives Objectives Measures Initiatives Targets Develop Clinical Excellence Internal Strive for Operational Excellence

28. Balanced Score Card Initiatives Objectives Measures Initiatives Targets Learning & Growth

29. Cascading the score card methodology to Radiology Department

30. Radiology - Strategy Map Vision: To be the most efficient, competent and courteous providers of comprehensive healthcare in the world.” Maximise Revenue FINANCIAL PERSPECTIVE Growth Opportunities Increased sales Technology Leadership & Operational Excellence CUSTOMER PERSPECTIVE Customer satisfaction and enhancement Offer full range of imaging services Provide on time service Operational Processes Create state of the art Information system -PACS Quality Reporting Patient Education On time Reporting Reducing Equipment Break down Reducing Film Wastage INTERNAL PERSPECTIVE A Motivated and Prepared Workforce Staff satisfaction and feedback Invest in Continuous Education LEARNING & GROWTH PERSPECTIVE Develop Communication Plan Recruit & Retain Professional & Technical Staff

31. A New Era of Accountability

32. Departmental meetings - Performance, Strategic directions All Meetings use the framework of the strategy map and score card to communicate priorities and report on performance Monthly results reported to the whole organization via the intranet A New Era of Accountability

33. A New Era of Accountability Monthly Executive Leadership Strategic Operating Review Meetings : - Review monthly performance indicators - Majority of the meeting spent discussing strategic issues within the context of the strategy Map Director Level bi-weekly initiative progress meetings

34. How is Balanced Score Card Helping us ? A complete paradigm shift for developing & implementing strategy Increased executive, management and physician/staff accountability, but now with clearly defined targets. Aligning the entire organisation through a common set of well understood objectives.

35. Consistency of message Improve patient satisfaction Effective communication tool for governance, administration, management and employees.

36. Finally… Quality is everyone’s job, and we need to do it right .