Interview with Barbara Possin, Vice-President for System Quality and Strategic Alignment, St Mary’s/Duluth Clinic Health System

Headquartered in Duluth, Minnesota, USA, St. Mary’s/Duluth Clinic Health System (SMDC) incorporates 20 clinics, four hospitals and an array of specialty care services to the people of northern Minnesota, western Wisconsin and Michigan.  Fiscal 2003-2004 revenues were about $656.5 million and it has about 6,300 employees.

SMDC was inducted into the prestigious Balanced Scorecard Collaborative Hall of Fame in 2002.

How long have you been responsible for facilitating the Balanced Scorecard process?

Since March 2000.

Are you full-time or part-time in your role as a scorecard manager? 

I am responsible for the Balanced Scorecard on a part-time basis. With ebbs and flows depending on the time of the year etc., it accounts for about 30% of my time.

I am also responsible for quality, which is of huge importance in healthcare and for ensuring that our quality efforts are fully aligned with our strategy. I also have responsibility for other support departments (Quality, Infection Control, Patient Safety, Patient Education, Chronic Disease Management Program and HIM).

Who do you report to?

I report to the Executive Vice-President of Duluth Clinic, who reports to the CEO.

How did you first get involved with the balanced scorecard?

In 2000 we engaged the Balanced Scorecard Collaborative (BSCol) to work with us on the scorecarding process and they strongly suggested that we needed a project manager to be responsible for day-to-day management of the scorecard process. I was identified as that person.

Unlike HR or Finance, as examples, there are no clear job descriptions for a ‘Balanced Scorecard’ manager. What did your organization see as the key personal and professional qualities for your role in scorecard facilitation?

Prior to introducing the scorecard, I had been involved in some major change programs, such as Y2K for instance. Such experiences meant I had developed skills around working with, and influencing, others across the organization, and at various hierarchical levels. So the senior team thought me a good fit for the scorecard, which is a major change project.

I was also seen as someone who could both see the big picture and implement the details.

Another plus I guess was that I had been working for the organization for about seven years and had developed good networks, which would be useful for getting the message out.

How were you trained in facilitating a Balanced Scorecard program?

To familiarize myself with the methodology I attended several Balanced Scorecard Collaborative (BSCol) sponsored workshops and we learnt from BSCol during the early scorecard work. The BSCol consultants proved very useful in passing on their knowledge and expertise.

I also used Professor Kaplan and Dr. Norton’s books as an ongoing aid.

What is your functional background, and how useful was this in your role in managing a Balanced Scorecard program?

I am a nurse by background. Although this wasn’t vital for the role, it did mean
that I understood healthcare specific processes and measures that are core to our business. It also meant that I could speak to physicians and other clinicians in their own language. So my background certainly helped in getting early buy-in to the scorecard. But the scorecard is so well-entrenched now that I don’t think a clinical background is as important now.

A Balanced Scorecard has to become ‘the way we manage around here’. From where do you get the authority (for example from the CEO) to go into a team and say ‘we’re going to build a Balanced Scorecard’?

From the very start of our scorecard efforts we’ve had strong commitment and sponsorship from the senior team, especially from the CEO Dr. Peter Person. 

Indeed, over the past couple of years we’ve undergone extensive organizational restructuring and just about all of the senior team has left except for the CEO. That Dr. Person has remained is partly why the scorecard has remained central to the way we manage as he had said that as long as he’s CEO we will use the scorecard. But I also firmly believe that even if he left the scorecard would remain our core management tool, as it’s now so well-engrained in our culture.

What are the major challenges you face when facilitating the process of building and implementing Balanced Scorecards and how are these overcome?

As with any change program, people respond according to a continuum from the enthusiastic early adopters to those who believe that all they have to do is keep a low profile and it will eventually go away.  So it is very important to keep communicating the messages that the scorecard is not a defined project but rather the way we will manage the business on a continual basis. Senior management commitment is crucial if people are to accept this message.

Overcoming challenges is also about showing people that the scorecard will make their job easier and that it is not just one extra thing to do. If it doesn’t make their work easier then there’s something wrong with the scorecard.

I am also fortunate in that we have a very able and creative Public Relations department that works hard to support the scorecard effort throughout SMDC in all internal communications. For example, they always explain how any new initiative that the organization launches, such as improving the admissions process, links back to the Strategy Map and Balanced Scorecard.

Are there people dedicated full-time or part-time to the scorecard within your organization? If so, what are their roles?

In terms of support we don’t characterize people as scorecard people, but there are people throughout SMDC who, as part of a wider role, will maintain the scorecard. This ranges from good secretarial support in ensuring metrics are collected and reported to senior managers who will define the metrics.

Actually, post consultancy support, I was the only SMDC employee involved in the scorecard implementation process. I have always felt that at the highest level the scorecard process should be relatively simple, although it does become increasingly more complex the further down it is cascaded.

How do you see your role developing over the next 2-3 years?

I see my role developing more along the lines of an internal consultant. The role will be more focused on helping local operations managers use the scorecard to its full potential as both a mechanism for implementing strategy and as a tool for communicating strategy to their own people.

I really see my role as helping people use the scorecard as a strategic management tool and not just as a way to manage information.

What do you enjoy most about working with the Balanced Scorecard?

What I like the most is that it enables employees, who typically will have no concept of strategy, to really understand where the organization is going, what its strategic priorities are, what the organization must do to achieve these goals and how each employee can help in that realization. I also like the way it gets people focused in the same direction.

The scorecard has also changed the way I look at the world, offering new paradigms in both my personal and professional lives. I have also been able to travel to places such as Singapore and Spain as a result of scorecard duties, which are not opportunities that normally arise in healthcare.

From your own career perspective, how do you think this role will benefit you personally in the longer-term?

I have already benefited in that since working with the scorecard I have been promoted from director of quality to my present position as a vice president.

From your experience what are the critical success factors in succeeding as a Balanced Scorecard manager?

One critical success factor is being able to take strategic thoughts and ideas and clearly articulate them within a Strategy Map. More, the manager has to be able to live with a certain amount of ambiguity, as strategy is rarely black and white.

It is also important to possess good communication and interpersonal skills, as is true for any major change program. 

A scorecard manager also has to be able to work with others and influence them without being overly imposing. It’s crucial that the scorecard manager realizes that they are facilitators, not dictators. The scorecard has to be owned by frontline managers.