This study describes the development, implementation and evaluation of a standardized measure of the performance of federally funded community health centers in North Carolina. Relevance and usefulness of this measure were evaluated at the end of the study. As a result of this 6-month project, a one-page performance scorecard was developed to provide a timely measure of each community health center's organizational viability and mission fulfillment. The scorecard also enabled these centers to compare their performance with that of their peers. When considering developing similar performance measures, the comparative performance scorecard sets a viable example for other health care administrations including the Local Health Integration Networks in Ontario. Background: In the face of increasing service demands and funding restraints, health care decision-makers require timely and accurate information about their organization's performance and comparative information about their peers. Tools currently used in the US to measure and evaluate the performance of federally funded community health centres (i.e. safety net providers for the 45 million uninsured Americans) are regarded as inadequate insofar as they do not provide timely or concise information to decision-makers. This study describes the development, implementation and evaluation of a standardized measure of the performance of federally funded community health centers in North Carolina. The objectives of the scorecard were to provide timely information about each center's performance and to allow comparison with their peers. The study also sought to assess the perceived usefulness of and interest in the continuation of the scorecard.

Methods: Of the 22 community health centers in North Carolina, 14 participated in the 6-month project of developing a performance measure scorecard. Facilities were both single-site and multi-site and were located in both rural and urban areas. A representative of each participating center identified performance areas and indicators based on their perception of how each area contributed to mission fulfillment and organizational sustainability. Final selection of performance areas and indicators was based on group consensus. Four performance areas and 19 indicators within these areas were identified for the scorecard. The four areas included access to care, utilization and productivity, human resources, and financial performance. Data sources for performance measurement within these areas came from existing performance review protocols, audit reports, internal records and a data set that collects information on consumers, diagnoses and financial indicators of the centers. Based on these data, a one-page comparative scorecard (containing the minimum, maximum, median value, and their organization's calculated value for each indicator) and detailed summary report were provided to each center. Centers were surveyed for their views on the scorecard development process as well as its overall usefulness and relevance (1 = not relevant/useful to 5 = highly relevant/useful). Most scorecard development work was achieved via conference calls and emails.

Findings: A one-page comparative scorecard and companion report were created and disseminated to all participating centers. Based on center ratings, each scorecard indicator was given an average score of over 4 (out of a possible 5) for relevance. The four performance measurement areas were rated as being highly relevant with mean scores ranging from 4.7 for both Utilization and Productivity and Human Resources, to 4.9 for both Financial Performance and Access to Care. All respondents gave a rating of 5 for the usefulness of the scorecard, and indicated it was highly useful to managers for decision-making. They also indicated their scorecards could be shared with managers, department heads, finance committees and other key stakeholders, and that these scorecards could be used for board education, service planning, modifying operations, benchmarking and quality improvement.

Conclusions: Overall, the performance scorecard provided community health centers with information in four key performance areas common to all health service providers. Despite their diversity, it enabled centers to compare their performance with their peers in terms of mission fulfillment and organizational viability. This comparative scorecard serves as a time-efficient method for evaluating organizational performance, and for providing information that is essential for decision-making, planning, and quality improvement. Because all participating centers viewed the scorecard as acceptable, relevant, timely and easy to use, this performance measurement tool may set an example for other health care administrations, such as the Local Health Integration Networks in Ontario, as they develop performance measurement systems.

Reference: Radford A, Pink G, Ricketts T, Spade J. A Comparative Performance Scorecard for Federally Funded Community Health Centers in North Carolina. Journal of Healthcare Management. 2007; 52: 20 - 33.