Frequently Asked Questions on Community Balanced Scorecards
Especially as Used in Public Health or Community Health Improvement
This FAQ has been drawn from questions we have been asked in webinars and presentations. If you would like more context for these questions, please peruse the informational resources on our website or view the free recorded webinar “Community Balanced Scorecards to Meet Public Health Challenges.”
CBSC is community strategy management approach to align multiple partners in a community, region, or state behind a common strategy to achieve mutually desired goals. Balanced Scorecard tools are typically used by organizations to map their strategies based on cause-and-effect assumptions, align the entire organization behind that strategy, and use “driver-outcome measurement” to monitor and improve strategic performance. Community Balanced Scorecard tools combine the traditional approach with engagement of partners to enable faster, better progress toward desired community outcomes.
CBSC tools can, and have, been used separately to good effect, based on a community’s specific needs and resources at a given time. CBSC tools were initially designed to be used together, with a strategy map to create alignment and driver-outcome measurement to build a full community scorecard to measure and improve strategic results. However, some communities have benefited just from using strategy maps, and others have been creative in using the tools in new ways. For example, one community first engaged five community improvement task forces to develop strategy maps that aligned community health improvement efforts of multiple partners. Several years later, they used the complementary “Community Results Compact” tool to develop signed agreements with various business, nonprofit, and government organizations to help achieve a key community health improvement strategy. Each compact incorporates driver-outcome measurement to create individual accountability of each organization for specific measurable achievements (“drivers”) and mutual responsibility among partners for community outcomes they all want to improve. Some state and local health departments have also used strategy maps and driver-outcome measurement to build or improve their performance management systems as part of their preparation for accreditation.
Using our approach, it only takes three or four working meetings with a community partnership team or organizational team to develop a CBSC strategy map, with an assignment for team members to complete between each session.This process can take fewer meetings if a community has existing plans (e.g., a strategic plan or Community Health Improvement Plan) to use as a starting point (see FAQ #6). Most or all of the meetings can be online to save costs, though at least one on site face-to-face session is usually best. The actual calendar time depends most on how frequently your team can meet and how long team members need between assignments. We’ve helped teams complete their strategy maps in as little as three or four weeks, sometimes faster if working from existing plans. One national group that could only meet monthly took four months through a series of online meetings.
A balanced scorecard does not have to be fully built out to start using parts of it to measure and manage strategy implementation. So, once a strategy map is done, then you can pick your top priority strategic objectives to develop measures and initiatives and start implementing them. In that sense, implementation can start just a few weeks after a strategy map is completed. Timing of building out the rest of the scorecard is up to the implementing organization or partnership. If you have the capacity to keep people focused on developing details for objectives for a continuous period, the rest of the scorecard may be built in three to six months. If not, a useful approach is to add measures and other details a few objectives at a time to gradually build out the scorecard, and to start implementing each objective “detailed” in this way as soon as there is enough consensus among partners to proceed. So, even if it takes a year or more to fully develop a CBSC, a community or organization can start deriving benefits from the strategy much sooner.
Community Balanced Scorecards readily accommodate evidence-based approaches to public health issues. Organizational or community partnership teams developing CBSCs can draw on the knowledge base of evidenced-based approaches to craft CBSC strategic objectives or initiatives to implement the objectives. We encourage them to do so. Also, as a CBSC is implemented and data are collected over time for CBSC performance measures, a CBSC enables a community or state to generate its own evidence for the combination of approaches that works to improve performance and achieve desired outcomes.
Yes, you can use an existing strategic plan, community health improvement plan, grant action plan, other community improvement plan, or a combination of existing plans as sources to build one or more strategy maps and community balanced scorecards. We have worked with community partnerships and organizations to identify “strategic ideas” in existing plans and use those ideas to develop strategy maps and performance indicators for scorecards. To the extent that existing plans are open to change (some, such as grant plans, may not be) the exercises to build the cause-effect logic of balanced scorecards can bring new ideas to light to help a community improve their existing plans.
Several CBSC strategies can be aligned by using a “top level strategy map” that all the other community strategy maps are aligned with. For public health, we have developed a “PH Strategy Map Template” that a community or health department can use as a top level strategy map. Some community partnerships have used the template as a starting point to develop more specific community health improvement strategy maps. Some health departments have used the template as a top level strategy map to align strategy maps and performance plans of multiple community or department programs as part of their performance management system or strategic plan.
The Community Balanced Scorecard—especially a CBSC strategy map—is really a special kind of logic model because it is tailored to your specific strategy, rather than forcing your strategy into the logic model. For example, we think a CBSC is more powerful and dynamic than traditional logic models, which tend to tell you that you must create certain kinds of performance measures—sometimes called a “family of measures”—that mirror categories in the logic model. A balanced scorecard, instead, allows you to pick whatever performance measures make the most sense as drivers of the outcomes you want, without reference to the types of measures. So, you can focus in better on a strategic set of measures and leave out measures that don’t say much about your strategy. In this way, the Community Balanced Scorecard is a more flexible and strategic tool than a traditional logic model.
Staffing depends on your organization or community situation. It is important to have one point person who can spend a decent amount of time on coordinating effort, but that need not be someone who spends full time on a CBSC. The work can be distributed among many hands. The main goal is to save people time, so you if you have strategy maps in place, the process will require less time. You can start with one person as organizational or community coordinator. This coordinator can be the point person for the several programs or organizations in this effort. As you progress to several strategies with scorecards, it will obviously require more staff time. That’s when strategy management software such as InsightVision really pays off in greatly reducing staff time needed to coordinate data gathering and do various analyses, and enables you to focus staff time on making a strategy more effective rather than tracking down everyone’s data and crunching out lots of spreadsheets.
Balanced scorecards do not necessarily need to have a financial perspective. We initially developed three sets of model perspectives for community balanced scorecards based on building on the various assets of organizations and people collaborating to improve a community. Of course, financial objectives and performance measures can often be important for sustaining and improving community efforts. But financial objectives and measures can easily be accommodated in the “Community Assets” perspective. One variation of our initial model sets of perspectives turned out to be a great fit for the Ten Essential Services of Public Health. That led to our developing a template that gives community health partnerships and public health organizations a jump start—and some cost savings—in developing strategy maps and scorecards. We later extended the PH CBSC/Strategy Map Template a bit to add Public Health Accreditation Board domains 11 and 12 (PHAB domains 1–10 are the Essential Services of Public Health). PHAB domain 11 on administrative & management capacity accommodates financial objectives and measures.
CBSC works with a combination of individual and mutual accountability of partners. In a Community Balanced Scorecard, there are community outcomes all partners want to see improved, and there can be some “high level” performance drivers of those outcomes that multiple partners contribute to achieving. Then, there are partner-specific performance measures that are considered performance drivers of the community outcomes, high level performance drivers, or both. Each partner is accountable for achieving the targets for their specific performance measures. All partners are mutually accountable for achieving results of the high-level drivers and community outcomes. If most or all partners do well in meeting their individual targets but high-level drivers and community outcomes do not show expected results, it means the strategic logic built into the strategy should be re-examined. It may be based on incorrect cause-effect assumptions and need to be changed.
In one community, we helped a health improvement partnership use the “Community Results Compact” tool to develop signed agreements with various business, nonprofit, and government organizations to help achieve a key community health improvement strategy. Each compact incorporates driver-outcome measurement to create individual accountability of each organization for specific measurable achievements (“drivers”) and mutual responsibility among partners for community outcomes they all want to improve.