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Emergency Departments and Balanced Scorecard Assignment

Division Selection

Emergency departments (EDs) provide services to patients that are brought in by ambulance vehicles, but those getting to the hospital on their own can also receive services in cases of emergency. These departments are established to help patients with a variety of acute life-threatening conditions, such as injuries, heart attacks, cerebral accidents, and so on. However, the acute exacerbations of chronic health conditions can also be managed in the selected division.

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Article Review

Rahimi, Kavosi, Shojaei, and Kharazmi (2017) provide a comprehensive review of performance indicators used by healthcare organizations that implement the balanced scorecard approach. The research team mainly focuses on indicators that are applicable to diverse healthcare environments, but performance measures peculiar to EDs (ED waiting time, ED length of stay, etc.) are also discussed in a detailed manner. The source contains valuable information concerning the four balanced scorecard perspectives or the categories of measurement.

To continue, the source by Stefanini, Aloini, Benevento, Dulmin, and Mininno (2018) explores the issues of performance measurement in EDs, such as the lack of specificity. The researchers review and evaluate twenty performance indicators that refer to patients’ perspectives on care, time measures, and resource utilization. The study provides multiple recommendations concerning analyzing the effects of the patient flow on daily activities.

Finally, Yoo et al. (2018) delve into performance measurement in EDs with special attention to the development of real-time and autonomous dashboards for the selected hospital division. The researchers demonstrate an example of an effective dashboard that has been tested in an ED with high crowding. The article is specifically focused on evaluating nurse- and physician-reported usability of the performance measurement tool in question.

Categories of Measurement

Despite the complexity of services, EDs share multiple similarities with any other businesses. The selected division has a workforce consisting of diverse specialists and serves a number of clients who expect to get timely and high-quality care. Also, any ED has to locate human and financial resources to conduct effective internal processes and control them. Considering that, it is possible to use the four traditional elements of the balanced scorecard framework as the broad categories of measurement. Among these categories are the financial aspects of performance, internal processes, growth/development as it pertains to staff members, and performance from the healthcare consumer’s perspective (Rahimi et al., 2017).

Performance Indicators

Staff Development

The first performance measure is the personnel satisfaction rate (Rahimi et al., 2017). The data may come from the employee satisfaction index (ESI) survey with questions pertaining to satisfaction, expectations, and similar issues. Regarding calculations, there are specific ESI formulas that vary depending on the number of survey questions. ED staff turnover is the second measure (Rahimi et al., 2017). The calculations involve dividing the number of ED employees who left the department during the period in question by the average number of people employed during the period and multiplying the quotient by 100. The third measure is the ED employee absenteeism rate (Rahimi et al., 2017; Stefanini et al., 2018). It is calculated by dividing the number of unjustified absences during the analyzed period by the result of multiplying the number of working days in the period and the average number of employees. The quotient is then multiplied by 100 to get the absenteeism rate.

Internal Processes

The waiting time for triage is the first indicator that can be used (Stefanini et al., 2018; Yoo et al., 2018). It is measured by calculating the average number of minutes between the recorded time of arrival and the start of triage. The next indicator that can be of use is the average “length of stay for discharged patients” (Stefanini et al., 2018, p. 135). To measure it, one needs to calculate the total period of hospitalization for discharged patients and divide it by the number of discharged patients. The third indicator is the ED mortality rate; it is calculated by dividing the number of recorded deaths by the total number of admitted patients and multiplying the result by 100.

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Performance from the Customer’s Perspective

The unplanned re-attendance rate can be calculated by dividing the number of patients re-admitted to the ED within three days by the total number of patients and multiplying the quotient by 100. Next, the patient complaint rate is a popular indicator (Rahimi et al., 2017). It is calculated by dividing the number of care quality complaints from patients by the total number of patients and multiplying the quotient by 100. The third indicator that can be proposed is the rate of the so-called “left without being seen” (LWBS) patients (Stefanini et al., 2018, p. 135). First, patient records should be used to calculate the number of patients that were registered but did not undergo medical screening examinations. The result is when divided by total ED encounters and multiplied by 100.

Financial Performance

The first indicator refers to the size of personnel costs (Stefanini et al., 2018). It is measured by dividing total personnel costs (compensation, training, wages, etc.) by total ED costs and then multiplying the result by 100. Other indicators are average hospitalization expenditures per person (total hospitalization expenditures divided by the number of patients) and the indicator measured by calculating ratio of total revenue to total costs (Stefanini et al., 2018).

Different Analysis Levels

Not all of the measures above could be used to analyze an entire organization’s performance instead of focusing on EDs. For instance, the indicator linked to LWBS patients would need to be replaced by something else since it is of utmost importance to measuring emergency care quality. As for the mortality rate, it would be more practical to calculate it for different divisions individually since the risks of lethal outcomes vary across departments.


Rahimi, H., Kavosi, Z., Shojaei, P., & Kharazmi, E. (2017). Key performance indicators in hospital based on balanced scorecard model. Journal of Health Management & Informatics, 4(1), 17-24.

Stefanini, A., Aloini, D., Benevento, E., Dulmin, R., & Mininno, V. (2018). Performance analysis in emergency departments: A data-driven approach. Measuring Business Excellence, 22(2), 130-145.

Yoo, J., Jung, K. Y., Kim, T., Lee, T., Hwang, S. Y., Yoon, H.,… Choi, J. S. (2018). A real-time autonomous dashboard for the emergency department: 5-year case study. JMIR mHealth and uHealth, 6(11), e10666.

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