By Lyle Wray, Ph.D., executive director, Capitol Region Council of Governments, Hartford, Connecticut (firstname.lastname@example.org), and Paul Epstein, leader of the Results That Matter Team (www.RTMteam.net), Epstein & Fass Associates, New York, New York (paul@RTMteam.net).
Figure 2 provides an example of a strategy map from Osceola County, Florida. This map was developed by a community health partnership focused on improving access to care for the uninsured and underinsured.
The map is based on the community balanced-scorecard methodology that uses perspectives to help structure the strategy, in this case using perspectives that work better for community health than perspectives typically used for organizational scorecards. Strategy maps don’t have to use balanced-scorecard perspectives. They do need to show driver relationships in the community’s improvement plans.
The Osceola County partnership, led by the county health department and the nonprofit organization, Community Vision, not only built the strategy from best practices but also planned to continue to seek evidence-based leadership practices to improve the quality of care, which is one of their drivers of better health outcomes.
For Osceola County, managers and partners want to measure the number of uninsured and underinsured people who have a “medical home” that for them is a regular source of primary care. This could be a family doctor or a community clinic where doctors and nurses know them, have records of their medical history, and can provide consistent, appropriate care to help them prevent or manage chronic conditions. That’s a key driver of improving diabetes and heart disease outcomes.
If it is found that the county is falling behind target on this or other performance drivers, this is an early warning that mid-course corrections are needed in the quest to improve the chances of achieving ultimate desired outcomes. By using driver relationships to guide selection of measures and analysis of data, a community partnership achieves strategic performance measurement.
Osceola County has even made performance measurement itself a key driver. What is learned when the county measures success will drive how it targets initiatives and will help sustain best-practice programs.
One action plan to increase enrollment in a primary care medical home (a strategic objective) is to expand diversion of patients with nonurgent problems from hospital emergency rooms to clinics that can enroll them as regular primary care patients. Partners with responsibilities for actions in this plan include hospitals in the county and the County Health Department, which operates several federally qualified health clinic sites.
Other partners that the partnership hopes to recruit to this action plan include charitable free clinics in the county run by nonprofit and faith-based organizations. This action plan is tied to performance measures for increasing the number of residents with a regular appropriate source of primary care and for reducing community health system costs, as each emergency room visit can cost as much as 10 times the cost of a patient visit in an appropriate primary care setting.