The Balanced Scorecard Approach: management tool for incentivising integrated care systems?

Purpose: The lack of both management skills and transparency of economical and quality outcomes are often stated to be two main deficits of integrated care systems in Germany. Performance management systems (PMS) are considered as a characteristic of professional management in „traditional“ (non-network) organizations. Also in network organizations in the health care sector there has been a rising recognition of the importance. A systematic review of design recommendations as well as studies that evaluate how this recommendations can be put into practice are to date still missing. Aims: Discuss a set of requirements of PMS (normative PMS conception) for integrated care systems and how they can be implemented in theory and praxis via a balanced scorecard approach (BSC). Methods: The discussion is based on the results of a triangulation of methods: a systematic literature review combined with a qualitative content analysis of expert interviews (n=10) to develop the normative PMS conception and a single case study to discuss the practical implementation process of a BSC in an integrated care system in Germany (Gesundes Kinzigtal). Results and conclusions: The study shows that the main requirements for PMS for integrated care systems are similar to PMS for „traditional“ (non-network) organizations (e.g. balanced, clear, strategy orientated and flexible measures; integration of the PMS into the management system of the organization, a continuous review and update etc.). But some obstacles have to be overcome to put such a PMS concept into action. In the case study especially the following challenges showed up in the implementation process of the BSC: the necessity of claims and clinical data, how to ensure timely feedback to the network partners within a positive cost-benefit ratio and the cultural dimensions of a non-hierarchical and lateral discourse without accusation about the results [cf. 1,2].