Wednesday, September 23, 2015

The Balanced Scorecard for Health Care Organizations

As clinical outcomes become more important in health care, methods to assess these outcomes become more important. A strategic management tool documented in a 1992 Harvard Business Review article written by Robert Kaplan and David Norton has gained prominence as a tool to measure "the outcomes of business strategies." And this tool is increasingly being used in the health care arena. The name of the tool documented by Norton and Kaplan is the Balanced Scorecard (BSC).

The BSC was designed to encourage managers to focus, in a more evenly distributed fashion, on four organizational components that contribute to an organization's success. These components are the financial component, the customer component, the internal operation component, and the learning and growth component.

Norton and Kaplan called these components perspectives. So the BSC encourages managers to view the organization from four perspectives. These perspectives are the financial perspective, the customer's perspective, the internal business process perspective, and the learning and growth perspective.

When considering the organization's financial perspective, the organization evaluates its financial affairs, and seeks to answer the following question: What does the organization need to do to improve its financial position? When considering the customer's perspective, the organization seeks to answer the following question: What does the organization need to do to satisfy its customers so that customers will purchase products or services?

When considering the internal business process perspective, the organization seeks to answer the following question: What internal processes does the organization need to perform to deliver to the customer the best product or service? And finally, when considering the learning and growth perspective, the organization seeks to answer the following question: What does the organization need to do to "continue to improve and create value?"

Once the organization answers these questions, the organization knows what objectives need to be achieved to satisfy each of the four perspectives. The organization can then establish these objectives,  construct targets for each one of the objectives, design measurements for each one of the objectives, and develop initiatives to achieve the objectives, using the measurements to determine success.

The objectives, targets, measurements, and initiatives are shown on a scorecard. And tracking these items for the four perspectives or domains will give executives a balanced view of the organization's strategic status.

Since 1992, organizations in different industries have used the BSC as part of their strategic business process. And while health care organizations were not among the first organizations to use the strategic tool, many health care organizations have begun to use the tool.

For example, an orthopedic medical practice of fourteen surgeons implemented the BSC, and the tool has benefited the practice. According to one source, "The BSC process resulted in increased engagement and ownership for the management team and was a positive exercise that created agreement about what processes and results are really important to our success." So, medical practices, including bariatric practices might want to consider BSC as a tool to measure outcomes.

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Wednesday, September 16, 2015

Two Companies Have Received FDA Approval for Their Intragastric Balloons


Minimally invasive weight loss procedures that are much less invasive than laparoscopically performed bariatric surgery include endoscopic methods. In endoscopic methods, the procedures are performed using the mouth as an entry point. One example of an endoscopic procedure is the intragastric balloon. And recently, two companies received FDA approval for their intragastric balloons.

One of the companies is San Clemente, California based ReShape Medical, Inc. And the other company is Austin, Texas based Apollo Endosurgery, Inc. Indeed, intragastric balloon usage has led to good weight loss results. In one study, the balloon produced safe and respectable average weight loss of 42.7697 pounds "without intensive lifestyle" intervention in 85% of 672 patients. The study's investigators did indicate that there were complications in about 6% of the patients. And 53 patients asked that the balloon be removed. But the balloon showed promise. And, apparently, results like those in this study led to the FDA approval.

Bariatric surgery is an effective weight loss approach. But according to the American Society of Metabolic and Bariatric Surgery, less than 2% of those who qualify for bariatric surgery actually get the surgery. There are a number of likely reasons why eligible persons don't get the surgery.

Cost is probably a barrier to the surgery. And some eligible persons balk at the all but irreversibility of most surgical weight loss procedures. Also, eligible obese persons fear the possible complications of the more drastic forms of the surgery. However, the minimally invasive weight loss procedures, such as the intragastric balloon, are less invasive than the most common forms of bariatric surgery. And these minimally invasive procedures, including the intragastric balloon, may eventually prove to be safe and effective long term.

As more minimally invasive weight loss procedures, like the intragastric balloon, are developed, weight loss providers will have more weight loss options for their patients. And with the newly available obesity drugs, surgeons and obesity medicine specialists may introduce procedures that combine these minimally invasive procedures with pharmacotherapy. Perhaps, using devices like the intragastric balloon with pharmacotherapy can eventually be safe, and as effective as gastric bypass surgery.

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