Sustainable Development in NHS Scotland

Introduction

Sustainable development is referred to a process of considering a holistic view about activities along with taking implications on the economic, social and environmental factors (Chang2007). In National Health Service (NHS), sustainable development generally aims to at the areas that involved regarding providing, using and managing different NHS healthcare facilities and services. The rising pressure, as well as the major shift of changes in external factors, have been radically influencing the need for sustainable development for the organization. This report aims to develop a balanced scorecard of the healthcare practices and performance of NHS Scotland by evaluating its range of key performance indicators (KPIs). Theoretically, balance scorecard plays a critical role to in performance management evaluation. It facilitates to monitor and measure organizational performance and assign the KPIs by providing the ability to trace and optimize performance by the indicators (NHS, 2018). For specific needs such as refining healthcare-related metrics, seeking business dissertation help can provide valuable guidance and support

Moreover, the report also details the weaknesses, gaps, and challenges faced by NHS Scotland and evaluate those challenges from financial, internal business process, learning and growth, and customer perspectives. The evaluation of these perspectives has enabled the report to determine the performance of NHS Scotland and to identify its measures towards addressing the impacts of the external pressures. And therefore, based on the results obtained from the balanced scorecard of the performance, the discussion provides a set of recommendations for NHS Scotland to sustain its growth and development in the UK’s healthcare industry.

Global External Pressure on NHS

NHS Scotland has been recognized to face tremendous challenges regarding bringing continuous improvement in its patient care processes at the time of immense financial pressure. According to the recent scenario, it has been exposed by the newspapers regarding it's uncaring as well as incompetent managerial and leadership practices (Quinn, 2018). Based on the arguments on the incompetent managerial and leadership practices, NHS Scotland is accused to distress the Scottish patients and families with delivering the worst experience in the name of offering healthcare services to the users.

Additionally, the increasing demands for healthcare as well as the situations in which the services will be delivered are become radically different for NHS Scotland due to the highly increasing demography of aging population in the country. Additionally, challenges derived from the sluggish economic condition is another key challenge that has been substantially creating challenges for NHS in Scotland. The lower growth in annual household expenditure with the higher inflation rate in the country has been substantially deteriorating the performance of the healthcare service sector, mainly NHS in the country (Ham et al., 2016). The survey result of Information Services Division (ISD) has revealed that managing of impacts faced by the aging population is of the major challenges for health and social care service sector in Scotland (Inamdar, 2002).

What is Balance Scorecard

Balance scorecard can be defined as a strategic performance management tool used by business entities to determine and improve different internal functions along with their resulting outcomes. Developed by Robert Kaplan and David Norton in 1990s, the balanced scorecard is also known as performance metric which can be used to measure and provide appropriate feedback to the organizations concerning their progress towards the fundamental strategic goals and objectives (NHS, 2018). It helps organizations to develop effective prioritization process of projects, products, and services by aligning the day-to-day activities of the organization. The following illustration critically outlines the key areas encompasses by balanced scorecard relationship of the system with the core vision of the organization:

While talking about its way of measuring and evaluating performance, balance scorecard tends to connect each aspect of the strategic element of an organization such as the underlying vision, strategic focus areas, and the core values of the organization. Moreover, it also connects the elements such as organizational objectives and measures relating to the KPIs that provide organizations to ascertain the long-term vision and financial objectives (Niven, 2003). Therefore, concerning the basic understanding about the concept, it can be said that balanced scorecard is one of the most effective strategic tools for any organization to appropriately measure the performance of the KPIs and enable them to leverage optimal result towards achieving the fundamental goals of the organization (Oliveira, 2001). Nevertheless, the performance metric also facilitates organizations to encompass all aspect of strategic areas of the organization and eventually improves the decision-making process to avert potential risks and other influencing factors derived from both internal and external environment.

Balanced Scorecard and NHS Scotland

A balanced scorecard is an integrated strategic approach in NHS Scotland. The performance metric used in healthcare services at NHS Scotland requires its managers and team leaders to maintain a continuous focus on the important performance metric that usually linked with the growth and development of the NHS. It enables NHS’s operational process to balance various perspectives such as its internal processes, learning, and growth, financial and patient or service users (NHS, 2018). Moreover, the balanced scorecard used in the strategic areas of NHS Scotland helps the organization to monitor its performance and seeks to capture of relevant and crucial information regarding how the organization is positioned to address its future strategic goals.

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Principles of Balanced Scorecard used in NHS Scotland

The strategic measurement metric provides a broader scope for NHS to link its strategic objectives to the KPIs

The unified and integrated set of KPIs that helps NHS to measure the critical activities and processes in various operational areas

Includes the system to identify hard and soft financial measures as well as their quantifiable operational processes

Provides clear guidelines for managers to accomplish the underlying mission of the organization

And facilitates managers to keep the workers and healthcare personnel and experts to remain motivated in their roles and responsibilities

Balanced Scorecard Weakness, Gaps, Challenges face for NHS

According to the evaluation of using balanced scorecard in NHS Scotland, the key perspectives have resulted in facing numbers of challenges and gaps. In various aspects relating to the process of measuring NHS’s performance from the perspective of internal business process, the balanced scorecard has been found to be insufficient for the NHS (NHS Estates, 2001).

When talking about the weaknesses, the implementation of the balanced scorecard in the performance measurement process usually a time consuming and expensive function for the organization. In NHS Scotland, the use of balanced scorecard has instigated problems associated with the functional aspects of the system, and it was required the organization to provide separate training and developmental sessions for the workers. Hence, it has imposed NHS Scotland to fetch increasing cost and time to implement the performance measurement metric (NHS, 2018).

Consequently, the implementation of the measurement metric, i.e., balanced scorecard has also certain loopholes relating to its relevance with the internal processes and all the elements of the organization. In NHS Scotland, the implementation of the tool has substantially drawn a gap relating to the inadequacy of the system regarding understanding the needs and requirements of the employees. Nevertheless, the execution of balanced scorecard in NHS also failed to provide a clear illustration about the financial performance of the company in the context of determining costs associated with the operational processes and healthcare services (NHS, 2018).

Analyzing different Perspectives of using Balanced Scorecard on the Business Operations of NHS Scotland

The evaluation of effeteness in the implementation of the balanced scorecard in NHS Scotland has been conducted based on the performance of this system in four KPIs such as financial, internal business process, learning and growth and customers or users of the organization.

Financial Perspective

From a financial perspective, the use of balanced scorecard is often recognized as an ideal tool for organizations to bring the financial performance of the firm in front of the key shareholders. The reporting process about the financial performance to the key group of stakeholders is crucial for any organization to sustain long-term. According to the current practice of NHS Scotland, the use of the performance metric in its financial reporting process helps the organization to maintain adequate clarity as well as the fairness of its investment in various health and wellbeing projects. The use of balanced scorecard has been enabling NHS to include detail information about annual earning and expenditure of the company (NHS, 2018). Moreover, it is also an ideal system for NHS to determine effective financial decisions and achieve financial goals that can attract the interest and engagement of the shareholders.

Internal Business Process Perspective

From the perspective of internal business process, the main intention of executing balanced scorecard in NHS is to identify the expectations and satisfy the needs of the stakeholders. Moreover, attracting potential stakeholders from multiple areas of the business environment was also a key objective for NHS. In this context, the process of integrating balanced scorecard in employee performance and skill development process has successfully helped the organization to meet the satisfaction level of the stakeholders and the community as well (NHS, 2018). In this context, the continuous process of identifying the training needs of the staff members to deliver quality based healthcare service facilities have significantly increased the demand for NHS healthcare services. Hence, the process has successfully increased the participation and engagement of the stakeholders.

Learning and Growth Perspective

The main purpose of integrating balanced scorecard in the strategic area of NHS is also to achieve the long-term vision of the organization. In this context, the implementation of the balanced scorecard has been enabling NHS to adopt continuous change and improvement in its operations and meeting the needs and expectations of the customers. NHS’s vision of offering ‘universal, equitable, comprehensive, high-quality healthcare free at the point of use’ has been successfully achieving by the company through using its sustainable process of developing business goals by the changing needs and trends in the modern healthcare industry (NHS, 2018).

Customer or User Perspective

In NHS Scotland, the implementation of the balanced scorecard is also focused on addressing all aspects from a customer perspective. This area is also related to the underlying long-term vision of the organization. Hence, the implementation of the performance measurement metric has enabled NHS to identify the changing needs of the users for any specific type of healthcare service. For instance, NHS outlines and provides a wide range of healthcare services for a range of acute diseases faced by the aging population (NHS, 2018). Moreover, the continuous focus on child improvement plans to encounter various health-related issues are few major areas that have been considered by the organization if we view from a user or customer perspective.

Limitation of Balance Scorecard

Although there have been identified numbers of benefits that an organization can gain using balanced scorecard, the system also has certain major disadvantages that can undermine the growth and development of the organization (Freeman, 2002). Few major limitations of using balanced scorecard system have been discussed below:

It is relatively complicated for some organizations as it requires the increasing number as well as a breath of the organizational performance. It comprises large numbers of performance measures across different perspectives that may be substantially difficult for organizations to implement this system appropriately.

Balanced scorecard in organizations may involve major restrictions which may not be possible to apply in organizations in a rapidly changing business environment.

The implementation of balanced scorecard may impose capital market pressure on the organizations as the system excludes the influence of factors from the external environment.

And finally, the implementation of balanced scorecard may impose a higher cost for organizations as it requires adequate knowledge and understanding of the employees and other staff members in the organization (Sim & Koh, 2001). Hence, before the implementation stage of the system, the organization requires to conduct appropriate training and development processes.

Conclusion and Recommendations

In modern business phenomenon, the use of balanced scorecard in measuring and monitoring organizational performance can deliver numbers of competitive opportunities for an organization (Chavan, 2009). However, the system is often argued to have numbers of issues relating to its relevance with the circumstances and factors associated with the external environmental factors along with its cost and time-consuming characteristics. About the case of NHS Scotland, the execution of balanced scorecard has eventually driven few major disadvantages despite its few key benefits in measuring and monitoring organizational performance (NHS, 2018). To successfully apply the balanced scorecard metric, a firm should use the system to clarify the goals and objectives of its team and develop a strategy for continuous improvement. Moreover, the organization should also include measures for using the system widespread across all the KPIs of the organization (Poll, 2001). This can enable the organization to understand the influence of external environmental factors and eventually develop effective measures to address them.

References

Chang, L. (2007). The NHS performance assessment framework as a balanced scorecard approach: Limitations and implications. International Journal of Public Sector Management, 20(2), 101-117.

Chavan, M. (2009). The Balanced Scorecard: A New Challenge. Journal of Management Development, 28(5), 393-406.

Kaplan, R. S. (2000). The Balanced Scorecard for Public Sector Organisations. Harvard Business School Press.

Freeman, T. (2002). Using Performance Indicators to Improve Health Care Quality in the Public Sector: A Review of the Literature. Health Services Management Research, 15(2), 126–137.

Inamdar, N. et al (2002). Applying the Balanced Scorecard in Healthcare Provider Organisations. Journal of Health Management, 47(3), 179–195.

Niven, P. R. (2003). Balanced Scorecard Step-by-Step for Government and Not-For-Profit Agencies. John Wiley and Sons Inc.

Oliveira, J. (2001). The Balanced Scorecard: An Integrative Approach to Performance Evaluation. Healthcare Financial Management, 55(5), 42–46.

Poll, R. (2001). Performance, processes and costs: managing service quality with the balanced scorecard. Library Trends, 49(4), 709-17.

Sim, K. L. & Koh, H. C. (2001). Balanced scorecard: a rising trend in strategic performance measurement. Measuring Business Excellence, 5(2), 18-26.