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Measure Up reader, Kenneth, works in a hospital and has this measurement challenge: “Different people want to follow up on different things. The nurses, for example, think it is crucial to follow up on how many phone calls they answer. I reckon it is because they want evidence to show management how they spend their time at work. But I do not think this is a critical KPI or success factor for our hospital. How do I draw the line? Do I need to draw the line? How can you get all people to accept this? The bigger question here might be: Who should have access to KPIs?”

Let’s start with an answer to Kenneth’s last question: Everyone should have access to KPIs. Everyone needs feedback on how well their efforts and collaborations are getting the intended results, and contributing to the hospital’s strategic direction.

But this isn’t the first challenge that Ken should tackle. If he were to go ahead and champion an effort to support everyone in getting performance measures they can use now, he’d likely create a quagmire of useless information and nurture a culture of defensiveness.

People would be creating measures of their activity and workload, not measures of their results. They would be using measures as a tool to defend their thus-far ignored complaints, rather than as a tool to improve their processes and results.

The clue is in Ken’s suspicions about why nurses want to measure the number of phone calls they answer. This is an activity measure, not a performance measure. It’s about actions, not results. And it is likely that nurses want to send a message to management that their time is being wasted on tasks that aren’t supporting what they know are the important results; namely patient care.

This is where Ken should start. On the important results. When an organisation can articulate it’s strategic results clearly, it can create a cause-effect cascade of results that reach right down to the processes that nurses work in.

These results are the things to be measured. The hospital might have a strategic result of reducing the length of stay of patients in the hospital. This might cascade to the processes that nurses work in, giving them a result of patient recovery speed. That would be one of their contributions to the hospital’s strategy.

Then in analysing how best to reduce patient recovery time, nurses might identify that administrative tasks (like answering phone calls) are consuming too much time. This cause-effect link to strategically important results would give nurses a powerful case for a process improvement initiative to streamline the most cumbersome of their administrative processes.

Measuring the number of phone calls they need to answer (among other admin tasks) is therefore a diagnostic measure, not a performance measure.

Results are at the heart of good performance measures; clear, specific, measurable results that come from strategic thinking. So Kenneth, build that results map before you worry about who should measure what. Measures are born from clear, specific, measurable results.

DISCUSSION:

What advice would you offer to Ken, to help him reach the outcome of people measuring what really matters?

1. Amanda Carthy says:

   February 3, 2015 at 11:11 am

   We had a similar issue with a great deal time spent on phone enquiries and research for customers (not a hospital situation though) We did a results map. The bottleneck was that there was no database of information that was easily accessible to deal quickly with enquiries/allow other areas within organisation to access or to be able to publish on our website. At the current rate of resourcing, we calculated that the database was going to take over 10 years to complete (wasnt seen as a funding priority outside of the branch). Armed with the results map and the 10 year calculation, we were able to secure resources to complete the database within a year.

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   • Stacey Barr says:

     February 5, 2015 at 3:57 pm

     Amanda, really??!! That’s incredible news. It’s another very cool example of how when you’re armed with evidence and logic, you really do have more influence than you might have otherwise imagined. Congratulations!

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2. Aleksey Savkin says:

   February 4, 2015 at 9:32 pm

   Stacey, thank you for sharing another great article!

   Is “results map” the same as “strategy map” or it’s some different concept?

   I believe the most challenging is actually aligning top level goal (reduce patient recovery time) with the goals for the nurses. The best case is when cause-and-effect logic is based not just on the intuition of hospital’s manager, but on some empirical findings.

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   • Stacey Barr says:

     February 5, 2015 at 3:54 pm

     Alesky, a Results Map (from PuMP methodology) is different to a Strategy Map (from Balanced Scorecard methodology). A Results Map shows in one diagram how the corporate strategy cascades to the operational and team levels, whereas you only see this in tiered strategy maps. Also a Results Map uses language that is more tangible and measurable than you’ll see in the strategic objectives in a Strategy Map. My personal preference is for a Results Map, because of both these reasons. But a few of my licensed PuMP Consultants are also practitioners of the Balanced Scorecard and they use the Results Map after they construct the Strategy Map. We’re still experimenting with ways to use both, and how they correlate to one another.

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3. Peder Enhorning says:

   February 9, 2015 at 4:49 am

   Great article and interesting idea of a map. Showing users how KPIs were determined, who is responsible for them and what progress is being made is really empowering. Everyone should have KPIs and everyone should know what everyone’s are!

   Our company is in the final stages of offering a service to help companies identify their KPIs and create a hierarchical map to track activities and actions which align to goals.

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4. Peter Ndaa says:

   February 17, 2015 at 4:18 pm

   Alesky, I have been working with strategy maps and result maps for the last one year and have found them to be complementary. The strategy map is an effective tool for designing strategy. It helps identify the value an organisation needs to deliver to its stakeholders and define and clarify the logic of how the value is created and delivered. Value are the mission and vision results referred to in PuMP. The strategy map captures this value as objectives in customer and financial/stewardship perspectives. How this value is created and delivered is captured by objectives in the process and organisation capacity perspectives. The objectives have desired outcomes or results and a result map is the perfect tool to check the rigour and logic of these results as well as test their measurability. I have found the result map as the bridge between strategy design and execution, including cascading.

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