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Ministerial Leadership Initiative Ministerial Leadership Initiative Ministerial Leadership Initiative Ministerial Leadership Initiative
For Global Health (MLI) For Global Health (MLI) For Global Health (MLI) For Global Health (MLI)
Bill & Melinda Gates Foundation Ethiopia Grantee Partners Meeting
March 29, 2010
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RahelRahelRahelRahel T. T. T. T. GizawGizawGizawGizaw –––– Country Lead for MLICountry Lead for MLICountry Lead for MLICountry Lead for MLI---- Ethiopia, Ethiopia, Ethiopia, Ethiopia,
Ministerial Leadership Initiative for Global HealthMinisterial Leadership Initiative for Global HealthMinisterial Leadership Initiative for Global HealthMinisterial Leadership Initiative for Global Health
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Presentation –Outline
• What is MLI?
• MLI Support to FMOH BSC Effort
• What is Balanced Scorecard(BSC)?
• Progress to date -MLI’s support on BSC
• Next steps/ Way forward
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Ministerial Leadership Initiative for
Global Health(MLI)
• MLI - a 4 year joint initiative of the – Aspen Institute, Aspen Institute, Aspen Institute, Aspen Institute, – Results for Development, Results for Development, Results for Development, Results for Development, – Council of Women World Leaders, Council of Women World Leaders, Council of Women World Leaders, Council of Women World Leaders, – World Health Organization (2008World Health Organization (2008World Health Organization (2008World Health Organization (2008----2011)2011)2011)2011)
• Funded by Bill & Melinda Gates and David and Lucile Packard Foundations
• MLI objectiveMLI objectiveMLI objectiveMLI objective: To strengthen the leadership capacity of ministries of health (“MLI 5”) to advance policy in three major areas:
1. Health financing for equity,1. Health financing for equity,1. Health financing for equity,1. Health financing for equity,2. Donor harmonization and alignment in health2. Donor harmonization and alignment in health2. Donor harmonization and alignment in health2. Donor harmonization and alignment in health3. Reproductive health*3. Reproductive health*3. Reproductive health*3. Reproductive health*
http://www.ministerial-leadership.org/
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* Reproductive Health support, funded through the Packard Foundation, focuses on Mali,
Senegal, and Sierra Leone.
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• DemandDemandDemandDemand----driven and Countrydriven and Countrydriven and Countrydriven and Country----LedLedLedLed: Countries choose their own
priority topics of focus within the 3 general policy areas
• PracticePracticePracticePractice----based Learningbased Learningbased Learningbased Learning: Strengthening leadership skills by working
on specific topics
• Technical Assistance and Leadership DevelopmentTechnical Assistance and Leadership DevelopmentTechnical Assistance and Leadership DevelopmentTechnical Assistance and Leadership Development: MLI provides
technical and related support
•Alignment: Alignment: Alignment: Alignment: MLI seeks to complement the work of MOH and
development partners
•CatalystCatalystCatalystCatalyst: MLI helps to leverage additional resources or support to
achieve MOH policy priorities
MLI Principles
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Sierra LeoneSierra LeoneSierra LeoneSierra Leone: Strengthening
financial
management and
donor coordination,
building
communications and
advocacy capacity
for reproductive
health
SenegalSenegalSenegalSenegal:
�District & hospital
resource allocation
formulas, strengthening
health SWAp,
policy/advocacy capacity
building for reproductive
health
MaliMaliMaliMali
�Scale-up of
community-based
health insurance
schemes and
strengthening financing
and capacity for
reproductive health
Nepal: Nepal: Nepal: Nepal:
�Preparing capacity
development strategy for new
Health Sector Program,
development partner
coordination and knowledge
management capacity building
EthiopiaEthiopiaEthiopiaEthiopia:Building and
implementing a
Balanced Scorecard
within the health
sector
MLI 5MLI 5MLI 5MLI 5
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MLI Assistance
Mechanisms:
MLI Assistance
Mechanisms:
In Country
•Practice-Based
Leadership
Development
•Demand-Driven
Technical Assistance
In Country
•Practice-Based
Leadership
Development
•Demand-Driven
Technical Assistance
Specialized
study tours
Global
meetings
GlobalGlobalGlobalGlobal
Peer learning
opportunities
Multi –
Country
collaborative
learning
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•Health Sector Development Program (HSDP)Health Sector Development Program (HSDP)Health Sector Development Program (HSDP)Health Sector Development Program (HSDP): : : : Despite the existence of
HSDP as a multi-year single strategic planning framework and strategy, there
still exist multiple planning frameworks within the FMOH. BSC helps to
simplify and streamline planning, monitoring and evaluation processes
•BusinessBusinessBusinessBusiness----Process Reengineering (BPR): Process Reengineering (BPR): Process Reengineering (BPR): Process Reengineering (BPR): The FMOH implemented BPR to
redesign work processes to increase efficiencies and create stronger
organizational structures. - BPR, as a form of strategic, customer-focused
process improvement, is expected to strengthen the BSC.
•BSC PilotsBSC PilotsBSC PilotsBSC Pilots: Hon. Minister Tedros applied the BSC approach as Head of
TRHB. In 2007 the FMOH piloted the BSC. FMOH convinced that with
adequate adaptation, the BSC approach could deliver significantly improved
performance throughout the health system.
Strategic initiatives that are the foundation for EthiopiaStrategic initiatives that are the foundation for EthiopiaStrategic initiatives that are the foundation for EthiopiaStrategic initiatives that are the foundation for Ethiopia’’’’s s s s
effort to implement a health sectoreffort to implement a health sectoreffort to implement a health sectoreffort to implement a health sector----wide BSC:wide BSC:wide BSC:wide BSC:
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•Announcement of Ethiopia selection for
MLI support –WHA 2008
•FMOH Submitted a proposal to MLI requesting
support for the Balanced Score Card- 2008
•MLI considered the request but more funds
were required than originally allocated
oMLI adjusted its global budget to accommodate the BSC
work in Ethiopia following a discussion with the Gates
Foundation in December 2008
•BSC work started in March 2009 – the MLI Country Lead came
on board to work closely with FMOH in coordinating, managing and
leading the BSC work
MLI Support to FMOH BSC Effort
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• Strategic Planning tool for focusing on most important things
• Management System for aligning the workforce and day to
day work with an organization’s mission and visions using
performance measure and initiatives
•A change initiative for visualizing and communicating
leadership intent and organization’s long term strategic intent
• The BSC breaks strategy into actionable components -
Strategic Objectives linked in a value creation story (a strategy
map) through four distinct Perspectives
•Each Objective has one or more associated Strategic
Performance Measures
•The BSC also contains Strategic Initiatives (projects) to attain
or maintain targeted levels of organizational performance
What is the Balanced Scorecard (BSC)?What is the Balanced Scorecard (BSC)?What is the Balanced Scorecard (BSC)?What is the Balanced Scorecard (BSC)?
The BSC is not just a measurement system!The BSC is not just a measurement system!The BSC is not just a measurement system!The BSC is not just a measurement system!
Afar Regional Hospital
Inauguration
New cardiac center
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Key Concept:Key Concept:Key Concept:Key Concept:Align Align Align Align Work and the Workforce to StrategyWork and the Workforce to StrategyWork and the Workforce to StrategyWork and the Workforce to Strategy
CustomerCustomerCustomerCustomer
ValuesValuesValuesValues
& Needs& Needs& Needs& Needs
MissionMissionMissionMissionMissionMissionMissionMission
VisionVisionVisionVisionVisionVisionVisionVision
OrganizationOrganizationOrganizationOrganization
ValuesValuesValuesValues
StakeholderStakeholderStakeholderStakeholder
ConsiderationsConsiderationsConsiderationsConsiderations
Policies &Policies &Policies &Policies &
GovernanceGovernanceGovernanceGovernancePoliticalPoliticalPoliticalPolitical
PrioritiesPrioritiesPrioritiesPriorities
StrategicStrategic
ObjectivesObjectives
Strategic
Initiatives
Strategy
Map
StrategyStrategyStrategyStrategyStrategyStrategyStrategyStrategy
StrategicStrategicStrategicStrategic
ResultsResultsResultsResults
Strategic Strategic Strategic Strategic
Themes/PrioritiesThemes/PrioritiesThemes/PrioritiesThemes/Priorities
PerformanceInformation
Performance
MeasuresMeasuresMeasuresMeasures &
Targets
ProgramsProgramsProgramsPrograms
ProductsProductsProductsProducts
ProjectsProjectsProjectsProjects
ServicesServicesServicesServices
PersonalPersonal
ObjectivesObjectivesSuccessFactors
Rewards, Recognition &
Incentives
ProjectsActivities
Tasks
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FMOHFMOHFMOHFMOHDirectorate
TeamIndividual
RHBRegional
Health
Bureau
RHBRegional
Health
Bureau
RHBRHB RHBRHB RHBRHB RHBRHBRHBRHB RHBRHB RHBRHB RHBRHB
Minister of
Health
ZoneZone
Woreda
Four Federal
Hospitals
Private
Sector
Providers
Kebele
FMOH Four Federal
Health Agencies
Four Federal
Health Agencies
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Honorable Minister
Tedros
Structure of the Ethiopian Health SectorStructure of the Ethiopian Health SectorStructure of the Ethiopian Health SectorStructure of the Ethiopian Health Sector
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Assessment Actions TakenAssessment Actions TakenAssessment Actions TakenAssessment Actions Taken(August 2009)(August 2009)(August 2009)(August 2009)
• Conducted initial interviews (at FMOH,4 Regions and 4 Hospitals)
• 77 Conducted-Balanced Scorecard Program Readiness
• 80 Survey responses (9 online)- Making progress questionnaire
• Conducted review of all FMOH strategic planning Guidance
• Assessed and analyzed gaps with current and best practice –
Government of Botswana and
• Prepared report of findings and recommendations, and developed a
detailed plan of action
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Key ObservationsKey ObservationsKey ObservationsKey Observations
• BSC Awareness high
• BPR efforts well assimilated
• Leadership commitment high
• Multiple planning frameworks in place
• BSC seen mainly a measurement and monitoring tool for
– Individual activity accomplishment and measurement
– BPR accomplishment
• Traditional Strategic Planning framework
• High Turn Over
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Key Assessment RecommendationsKey Assessment RecommendationsKey Assessment RecommendationsKey Assessment Recommendations
• Refocus Leadership on BSC as a Strategic Planning and Management
System
• Harmonize or eliminate duplicative / conflicting frameworks
• Leverage Current Planning Activities
• Conduct Leader and Staff capacity development
• Prototype Cascaded BSCs
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Summaries of Activities Completed Summaries of Activities Completed Summaries of Activities Completed Summaries of Activities Completed
to Dateto Dateto Dateto Date
�Three Leadership Workshops conducted ( Average 20+ leaders per
workshop)
�Established Health Sector BSC system
�FMOH BSC Certification courses (100+ certified)
� FMOH Orientation course (20 participants)
�FMCB (Ministry of Capacity Building) - Institutional Base (25
participants)
�BSC Manual and Cascading Manual (Final Drafts being updated)
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Health Sector BSC (Draft)
Development Process
1.FMOH – RHB Steering Committee developed mission,
vision and strategic themes for the health sector
2.Theme teams established at FMOH – developed Health
sector strategic objectives, strategic results and strategic map
for the sector
3.During 3rd leadership workshop – (FMOH + RHBs)with
support from BSCI – refined strategic themes and Strategic
maps
4.PPD with assistance from BSCI developed performance
measures and initiatives for health sector strategic objective
5.Draft Health sector BSC distributed to stakeholders for
comment – soon to be finalized
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Opportunities and ChallengesOpportunities and ChallengesOpportunities and ChallengesOpportunities and Challenges
Opportunities
• Leadership Engagement
at Federal Level
• Focus on BPR
• MCB – high involvement
on BSC
• Timing of BSC – for
HSDP IV Preparation
Challenges
• BSC Knowledge Gap &
misconceptions
• Limited Leadership
Engagement at regional
level- competing priorities
• Changing the heart and
minds of leaders
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National Strategic Guidance (PASDEP)Plan for Accelerated and Sustained Development to End PovertyPlan for Accelerated and Sustained Development to End PovertyPlan for Accelerated and Sustained Development to End PovertyPlan for Accelerated and Sustained Development to End Poverty
Health Sector Strategy (BSC)
FMOH
DirectorateDirectorate
Team
Regional Health BureauRegional Health Bureau
Zone
HO
Zone
HO
Woreda
HO
Woreda
HO
Kebele
HO
Kebele
HO
Four Federal
Health Agencies
Four Federal
Health Agencies
IndividualIndividual
Federal
Hospital
DirectorateDirectorate
TeamTeam
IndividualIndividualTeam
Individual
DirectorateDirectorate
TeamTeam
IndividualIndividual
Regional
Hospital
Regional
Hospital
TeamTeam
IndividualIndividual
TeamTeam
IndividualIndividual
TeamTeam
IndividualIndividualTeamTeam
IndividualIndividual
BSC Cascading ModelBSC Cascading ModelBSC Cascading ModelBSC Cascading Model
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Way Forward ContWay Forward ContWay Forward ContWay Forward Cont’’’’dddd
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Conclusion
•So much have been done in building the health sector BSC, however a lot
remains to be done in Building and implementation of a fully functional
strategic planning and management system(BSC) at all levels of the health
sector in Ethiopia.
•MLI hopes that with a support from Gates Foundation, MLI will continue
providing technical support to health sector in Ethiopia to realize the
implementation of a useful strategic planning and management system (BSC)
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Thank You!
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Supplemental
Slides
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Building & Implementing A Balanced Scorecard:Building & Implementing A Balanced Scorecard:Building & Implementing A Balanced Scorecard:Building & Implementing A Balanced Scorecard:Nine Steps To SuccessNine Steps To SuccessNine Steps To SuccessNine Steps To Success™
• BSC Development PlanBSC Development PlanBSC Development PlanBSC Development Plan• Strategic ElementsStrategic ElementsStrategic ElementsStrategic Elements• Change ManagementChange ManagementChange ManagementChange Management
• BSC Development PlanBSC Development PlanBSC Development PlanBSC Development PlanBSC Development PlanBSC Development PlanBSC Development PlanBSC Development Plan
•• Strategic ElementsStrategic ElementsStrategic ElementsStrategic ElementsStrategic ElementsStrategic ElementsStrategic ElementsStrategic Elements
•• Change ManagementChange ManagementChange ManagementChange ManagementChange ManagementChange ManagementChange ManagementChange Management
• Strategy ResultsStrategy ResultsStrategy ResultsStrategy Results• Revised StrategiesRevised StrategiesRevised StrategiesRevised Strategies•• Strategy ResultsStrategy ResultsStrategy ResultsStrategy ResultsStrategy ResultsStrategy ResultsStrategy ResultsStrategy Results•• Revised StrategiesRevised StrategiesRevised StrategiesRevised StrategiesRevised StrategiesRevised StrategiesRevised StrategiesRevised Strategies
• SoftwareSoftwareSoftwareSoftware• Performance Performance Performance Performance ReportingReportingReportingReporting• Knowledge Knowledge Knowledge Knowledge SharingSharingSharingSharing
•• SoftwareSoftwareSoftwareSoftwareSoftwareSoftwareSoftwareSoftware•• Performance Performance Performance Performance Performance Performance Performance Performance ReportingReportingReportingReportingReportingReportingReportingReporting•• Knowledge Knowledge Knowledge Knowledge Knowledge Knowledge Knowledge Knowledge SharingSharingSharingSharingSharingSharingSharingSharing
• Strategic ProjectsStrategic ProjectsStrategic ProjectsStrategic Projects•• Strategic ProjectsStrategic ProjectsStrategic ProjectsStrategic ProjectsStrategic ProjectsStrategic ProjectsStrategic ProjectsStrategic Projects
• Performance MeasuresPerformance MeasuresPerformance MeasuresPerformance Measures• TargetsTargetsTargetsTargets• BaselinesBaselinesBaselinesBaselines
•• Performance MeasuresPerformance MeasuresPerformance MeasuresPerformance MeasuresPerformance MeasuresPerformance MeasuresPerformance MeasuresPerformance Measures•• TargetsTargetsTargetsTargetsTargetsTargetsTargetsTargets•• BaselinesBaselinesBaselinesBaselinesBaselinesBaselinesBaselinesBaselines
•CauseCauseCauseCause----Effect LinksEffect LinksEffect LinksEffect Links••CauseCauseCauseCauseCauseCauseCauseCause--------Effect LinksEffect LinksEffect LinksEffect LinksEffect LinksEffect LinksEffect LinksEffect Links
• Strategy Action Strategy Action Strategy Action Strategy Action ComponentsComponentsComponentsComponents•• Strategy Action Strategy Action Strategy Action Strategy Action Strategy Action Strategy Action Strategy Action Strategy Action ComponentsComponentsComponentsComponentsComponentsComponentsComponentsComponents
• Customer ValueCustomer ValueCustomer ValueCustomer Value• Strategic ThemesStrategic ThemesStrategic ThemesStrategic Themes• Strategic ResultsStrategic ResultsStrategic ResultsStrategic Results
•• Customer ValueCustomer ValueCustomer ValueCustomer ValueCustomer ValueCustomer ValueCustomer ValueCustomer Value•• Strategic ThemesStrategic ThemesStrategic ThemesStrategic ThemesStrategic ThemesStrategic ThemesStrategic ThemesStrategic Themes•• Strategic ResultsStrategic ResultsStrategic ResultsStrategic ResultsStrategic ResultsStrategic ResultsStrategic ResultsStrategic Results
• AlignmentAlignmentAlignmentAlignment• Unit & Unit & Unit & Unit & Individual Individual Individual Individual ScorecardsScorecardsScorecardsScorecards
•• AlignmentAlignmentAlignmentAlignmentAlignmentAlignmentAlignmentAlignment•• Unit & Unit & Unit & Unit & Unit & Unit & Unit & Unit & Individual Individual Individual Individual Individual Individual Individual Individual ScorecardsScorecardsScorecardsScorecardsScorecardsScorecardsScorecardsScorecards
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Transformational
Change
TransformationaTransformationall
ChangeChange
AccountabilityOrganization
Individual
AccountabilityAccountabilityOrganizationOrganization
IndividualIndividual
Communications
Clarity
CommunicationCommunicationss
ClarityClarity
ReportingPerformance
Compliance
ReportingReportingPerformancePerformance
ComplianceCompliance
Early WarningEarly Early
WarningWarning
Strategy Focused Alignment & Execution
Vision – Strategy -- Employees
Strategy Focused Strategy Focused Alignment & ExecutionAlignment & Execution
Vision Vision –– Strategy Strategy ---- EmployeesEmployees
Features Of Balanced Scorecard Features Of Balanced Scorecard Features Of Balanced Scorecard Features Of Balanced Scorecard Performance Management SystemsPerformance Management SystemsPerformance Management SystemsPerformance Management Systems
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Key Technical FindingsKey Technical FindingsKey Technical FindingsKey Technical Findings
Critical Tier 1 BSC components not well communicated, not fully
developed or not in use
Management System Management System Management System Management System
ComponentComponentComponentComponent DDDDDDDDeeeeeeeevvvvvvvveeeeeeeellllllllooooooooppppppppeeeeeeeedddddddd PPPPPPPPaaaaaaaarrrrrrrrttttttttiiiiiiiiaaaaaaaallllllllllllllllyyyyyyyy
DDDDDDDDeeeeeeeevvvvvvvveeeeeeeellllllllooooooooppppppppeeeeeeeedddddddd NNNNNNNNooooooootttttttt
DDDDDDDDeeeeeeeevvvvvvvveeeeeeeellllllllooooooooppppppppeeeeeeeedddddddd CommentsCommentsCommentsComments
Mission XX Clearly Communicated
Vision XX Clearly Communicated
Communication and Change
Management Plan XX In place and functional
Overarching Strategic Result Status Unknown
Organizations Core Values XXXXXXXX Require Review and to be
continuously communicated
Enablers/Pains XXXXXXXX Require update
Customers and Stakeholders XXXXXXXX Require update
Customer Value Proposition XXXXXXXX Require update
Perspectives, Strategic Themes
and Results XXXXXXXX
Strategic Themes narrow;
perspectives not in logical
sequence
Strategic Objectives XXXXXXXX Commentary?
Strategy Map XXXXXXXX Not visible and not wildly known
throughout the sector
Performance Measures and
Targets XXXXXXXX Require update
Strategic Initiatives XXXXXXXX Require update
Balanced Scorecard Graphic XX Not widely disseminated
Strategic Plan & Story XXXXXXXX Should emanate from BSC
Implementation Plan XX On wrong track
Cascading Plan XX By activity not by BSC Strategic
Objective
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Sector
FMOH, Agencies, RHBs
Individuals
Hospitals, Directorates, Teams
Way ForwardWay ForwardWay ForwardWay Forward
Cascading Cascading Cascading Cascading
27
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Health Sector Strategy (BSC)
FMOH (Tier 1 BSC)
Medical Services
Directorate
Medical Services
Directorate
Federal
Hospital
Team
Individual
DirectorateDirectorate
Team
IndividualIndividual
Team
IndividualIndividual
FMOH BSC ModelFMOH BSC ModelFMOH BSC ModelFMOH BSC Model
28
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Four Federal
Health Agencies
Four Federal
Health Agencies
DirectorateDirectorate
TeamTeam
IndividualIndividual
Health Sector Strategy (BSC)
Federal Health Agency BSC ModelFederal Health Agency BSC ModelFederal Health Agency BSC ModelFederal Health Agency BSC Model
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Regional
Hospital
Regional
Hospital
Regional Health Bureau BSCRegional Health Bureau BSC
Zone
HO
Zone
HO
Woreda
HO
Woreda
HO
Kebele
HO
Kebele
HO
DirectorateDirectorate
TeamTeam
IndividualIndividualTeamTeam
IndividualIndividual
TeamTeam
IndividualIndividual
TeamTeam
IndividualIndividualTeamTeam
IndividualIndividual
Zonal
Hospital
Zonal
Hospital
TeamTeam
IndividualIndividual
Health Sector Strategy (BSC)
Regional Health Bureau BSC ModelRegional Health Bureau BSC ModelRegional Health Bureau BSC ModelRegional Health Bureau BSC Model
30
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Four Federal
Health Agencies
Four Federal
Health Agencies
DirectorateDirectorate
TeamTeam
IndividualIndividual
Health Sector Strategy (BSC)
Federal Health Agency BSC ModelFederal Health Agency BSC ModelFederal Health Agency BSC ModelFederal Health Agency BSC Model
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Sustaining the Scorecard SystemSustaining the Scorecard SystemSustaining the Scorecard SystemSustaining the Scorecard SystemBuild the foundations:
Maintain committed and engaged leadership, and interactive
communications; lead transformation from the top by living the desired
behaviors
Support the continued effort by establishing a strategy management office
Enhance individual accountability for results through objective ownership
Emphasize continual improvement -- in processes, in employee learning and
skills development, and in understanding customer needs and satisfaction,
and in ensuring employee satisfaction
Leverage training cost-effectively (mass training doesn't work well!)
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Maintain Focus and AlignmentMaintain Focus and AlignmentMaintain Focus and AlignmentMaintain Focus and Alignment:Align organization strategy by using the balanced scorecard as the strategic
planning and management framework
Focus the organization on strategy by holding review meetings organized around
strategy (e.g., Strategic Themes) and Perspectives
Align the organization, systems and employee performance around strategy
through a rewards and recognition program
Link budget formulation, cost accounting, and performance results
Link key organizational initiatives into the balanced scorecard development
process ( BPR)
Sustaining the Scorecard System ContSustaining the Scorecard System ContSustaining the Scorecard System ContSustaining the Scorecard System Cont’’’’dddd