Chapter 2

CEIS Health Report 2006
Locarno, the aim being to test its validity before Head Office decided to implement it in
other facilities belonging to the multi-site hospital.
The EOC management clearly did not overestimate the strategic significance of BSC: it
was found capable of illustrating corporate strategy more systematically, but certainly did
not lead to an overall redefinition of existing strategy which had been in place for years.
Indeed the risk of losing cause-and-effect consistency among the aims of various key
performance areas and the invariably complex quantification of non-financial indicators
is a constant threat to the BSC model as defined by the hospital.
3.5.3 Agència Valenciana de Salut
Unlike the previous example involving a multi-site hospital, the Agència Valenciana de
Salut (AVS) is an entire regional healthcare agency, largely comparable to Italy’s Regional
Healthcare System. The regional healthcare agency of Valencia was set up in 2003 and
includes 21 healthcare departments, or districts, for whom it establishes healthcare
policy and provides the necessary institutional framework for allocating resources to fund
the care offered. Somewhat similarly to the Italian local public healthcare unit (Azienda
Sanitaria Locale), each AVS department has its own administration, which manages
resources, organizes services and coordinates professional staff. Approximately 45.000
full-time staff are employed in the area for which the AVS is responsible, who manage
some 400.000 annual admissions and more than 50 million primary care consultations.
As regards the use of the Balanced Scorecard, it should be noted that the AVS actually
used the BSC approach to set up its strategic action plan. Figure 2 illustrates the AVS
strategy map showing clear evidence of the underlying BSC approach. It sets out expected
outcomes, stakeholders, internal process action levers and future growth drivers.
The BSC model is comprised of 4 perspectives, 3 stakeholders and relative value propositions,
7 interventions and 4 future growth issues. All this amounts to 24 strategic
objectives, related to 43 indicators.
It is particularly interesting to note that the traditional economic/financial perspective has
been defined more broadly as “outcomes”, based on the need to clearly state that the
main goal of AVS is to deliver healthcare services that meet the expectations of the population,
while maintaining the economic sustainability of the overall reference health care
system.
In putting together the BSC model, AVS was determined to define the internal processes
perspective in the utmost detail, and accordingly set out an impressive 15 key performance
areas, thus clearly identifying the numerous actions that AVS intended to leverage.
The BSC system adopted by AVS is unique in that its role is to optimize strategic consistency
between the corporate level and the individual departments. The strategy map
for the whole organization can in point of fact be viewed as a corporate strategy map,
insofar as it provides a benchmark for the action of the individual departments. This is
because there is a risk that the department strategy plans could diverge from the overall
plan of the whole organization.
The following two criteria are used to analyse the consistency of the 21 local plans with
the corporate strategic plan:
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