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Slide 2: The health care consulting group of Kurt Salmon Associates, Inc. (KSA) provides management advisory services in facility planning, strategy, and information technology to multi-hospital systems, community hospitals, academic medical centers, children’s hospitals, and physician group practices. Today, the group is among North America’s most dedicated and experienced resources to health care providers. We work closely with our clients to raise the critical questions, explore the full range of vision and possible innovation, and develop recommendations that can be implemented. © Copyright Kurt Salmon Associates, 2004
Slide 3: Foreword HEALTH CARE ORGANIZATIONS CONTINUE TO BE BUFFETED BY A PERFECT STORM THAT IS BOTH POWERFUL IN FORCE AND NATIONAL IN SCALE. This storm is a confluence of forces, including the economy, labor shortages, revenue pressures, 1 and industry interventions regarding demonstrable patient safety, quality, and performance. In striving to navigate their local markets and reach their goals, health care organizations are devising and attempting to implement various strategies, including revenue cycle management, clinical process redesign, and Six Sigma. Drs. Robert Kaplan and David Norton of the Harvard Business School have observed that it is not necessarily bad strategies that lead to inferior performance, but the inability to effectively deploy, communicate, monitor, and refine those strategies.1 As organizations steer their way through dynamic and turbulent competitive environments, the corporate business plan — a compendium of strategies, objectives, and goals — serves as the navigational chart leading them to superior performance. The performance management system, as a business planning framework, strategy deployment tool, performance improvement methodology, and measurement approach, is of growing interest throughout the industry as a means of bringing the corporate business plan into the 21st century. Promising to transition corporate strategic planning from navigation by the stars and whims of the wind, to a system of information technologies, automation, and the seamless flow of information, intelligence, and best practices, performance management ensures the entire organization is working toward a common purpose. Many of Kurt Salmon Associates’ (KSA) clients, both in the health care and retail/consumer products industries, are pursuing performance management initiatives to address the tactical gap between strategy definition and deployment. The performance challenge is how best to link strategic objectives to high-performing operations. Drs. Kaplan and Norton address this performance management limitation through the introduction of the Balanced ScoreCard (BSC) in their seminal article and subsequent book, “The Balanced ScoreCard: Translating Strategy into Action” (1996). The BSC is a performance management system for devising strategic objectives and translating them into a focused set of performance measures which, in turn, focus and drive decision makers’ tactical and operational activities. KSA considers the BSC and similar approaches, such as Management-by-Objectives (MBO), Malcolm Baldridge National Quality Award criteria, and ISO 9000, to be performance management systems. These systems call for the development of a corporate business plan, its communication to the workforce, and monitoring and feedback to ensure the workforce, from CEO to staff nurse, is focused on working together in the pursuit of the business plan. This KSA Catalyst explores the definition and application of BSC performance management systems within health care provider organizations and considers enabling performance management information technology strategies and solutions to help health care organizations navigate the perfect storm. 1 Kaplan, Robert S., Norton, David P “The Balanced Scorecard: Translating Strategy Into Action,” Harvard Business School Press 1996. ., Performance Management Systems | Navigating the Perfect Storm
Slide 4: Kurt Salmon Associates | Catalyst, Summer 2004
Slide 5: Charting the Course Organization Performance Measurement The theory of the BSC performance measurement framework emphasizes the use of A CRITICAL ELEMENT OF ANY ORGANIZATION’S OVERALL PERFORMANCE MANAGEMENT SYSTEM IS KNOWING WHERE THE ORGANIZATION IS RELATIVE TO WHERE IT WANTS TO BE. This per- financial and non-financial measures in a balanced manner. average length-of-stay, inpatient/outpatient volume). These traditional measurements focus management attention on past performance, and provide only a short-term view of 3 formance monitoring is achieved through the provision of accurate, timely, and pertinent measurements to the decision makers of the organization. Managers have long recognized the need to measure organizational activities. As the management adage goes: “If you can’t measure it, you can’t manage it.” However, despite this recognition, most health care organizations do not manage themselves with performance measurement systems that provide visibility into the full continuum of corporate activities that result in superior performance. Superior performance is achieved with the effective synthesis of four perspectives of corporate activities: 1) finances, 2) human resources, and 3) internal processes, all integrated to increase 4) the value proposition of health care delivery to patients and other key stakeholders (see Figure 1). A performance management system based solely on measuring a single perspective, typically finances, has limitations. Current health care performance measurements are dominated by financial reporting indicators (e.g., operating expenses, gross charges, case mix index, achieving corporate objectives. Managers hone in on the previous month’s expense budget numbers, rather than balancing the evaluation and performance improvement of the intangible assets: effective processes, skilled and satisfied human resources, and the patient care value proposition necessary to maximize performance across the four perspectives. This is analogous to steering the Queen Mary II to its port of call across two oceans by virtue of only a speedometer and a rear-view mirror. The theory of the BSC performance measurement framework emphasizes the use of financial and non-financial measures in a balanced manner. These measures are connected to a cause-and-effect view of the organization’s activities along the four performance perspectives. The premise is that measuring and managing the learning and growth of human resources and improving the effectiveness and efficiency of internal processes will lead to improved customer satisfaction and loyalty, which results in superior long-term financial performance. Performance Management Systems | Navigating the Perfect Storm
Slide 6: FIGURE 1: BALANCED SCORECARD PERSPECTIVES A “balanced” set of corporate performance indicators goes beyond the financial 4 Financial Economic consequences of past actions Income Expenses Profit margin Cash flow Loss of sale Customer Value proposition delivered to customer segments Patient, physicians, payers, community Customer satisfaction Retention Acquisition Valued services Strategy Business Process Current and new internal business processes in which the HCO must excel Supply chain efficiency Achieving valued services Effectiveness of care Surgical infection rate Pathway compliance Learning and Growth Infrastructure to build long-term growth and improvement Employee satisfaction Human resource reskilling Information technology Wound care training Source: Illustrative example This is Management Theory 101. The innovative heart of the BSC approach is to explicitly select, gauge, and organize focused measures of the four performance perspectives, and to deliver them to decision makers in a timely and actionable manner via a BSC report. The BSC, however, is more than a scorecard of key performance measures. To truly measure performance for purposes of evaluation and improvement, and not just documentation, there must be a cause-and-effect connection between the business plan objectives and their operational realization. That is, employees and managers must use performance measures directly related to their daily tactical and operational activities — measures that let Operations know when to turn left, when to slow down, and when to stop. Performance indicators that amount to documented spilled milk (i.e., you lost $2 million in cardiology last year) do not help managers achieve corporate strategies. Did we lose $2 million because of missed cost objectives or revenue objectives, or both? What processes and essential resource capabilities are critical to improved performance of the cardiology product line? Are our patients dissatisfied with key aspects of service delivery and/or medical care? Why? Each question requires an element of outcome measurement in the BSC. Each outcome measurement must also be linked in an explicit cause-and-effect relationship to the measurement of a supporting process or driver that enables the achievement of the goal (see Figure 2). This outcome measurement is called a lagging indicator in BSC parlance, as it measures what has already happened: costs decreased, revenue increased, quality decreased. The driver measurement is called a leading indicator, as it measures the capability to achieve performance in the future: 90% of cases are being managed by a critical pathway; 75% of case managers have received Six Sigma training. A scorecard that explicitly connects leading and lagging measurements allows decision makers to take action on processes that will improve desired outcomes. An example: If for no other reason than habit, a cause- Kurt Salmon Associates | Catalyst, Summer 2004
Slide 7: FIGURE 2: BALANCED SCORECARD CAUSE-AND-EFFECT CHAINS Learning Process Customer Finance ome Drive r Outc Post-surgery infection rate increases Satisfied patients decreases Profit margin decreases 5 Wound care training % of staff decreases Loss of sales increases Source: Illustrative example and-effect chain begins with financial outcome measures, such as product line profitability. One way to reduce costs and increase profitability, at least for case-based reimbursement, is to reduce length-of-stay (LOS) in a medically responsible way. The LOS lagging outcome measure requires a leading driver measure to indicate how the desired LOS outcome is to be achieved. The percentage of discharges in compliance with developed critical pathways could be a meaningful driver measure. An increased patient satisfaction score on the latest Press Ganey survey indicates proper balance between aggressive case management and patient satisfaction. Have these improvements led to greater center of excellence market share, and therefore revenue stream? There should be a metric in place to answer this question. Dozens of permutations exist for how performance measures can relate to each other; and in turn, how the strategic objectives they represent also relate to and affect each other. Designing a Performance Scorecard The BSC management system is as effective when applied to an individual line of business as when applied to the corporate-level business plan. To illustrate, we will apply the BSC performance management system to a corporate strategy to develop a cardiology center-of-excellence service line. There are two broad tasks: devising the service line business plan and designing the scorecard to monitor and manage the performance of that business plan. During a planning session, management and the clinical team have identified three strategic goals for the cardiology center-of-excellence: 1. Be recognized as the choice for cardiology cost/quality performance in the region. 2. Identify, target, and lead in the three “customer” segments (patient, physician, and insurance product). 3. Improve the quality and efficiency of cardiology patient clinical management. Performance Management Systems | Navigating the Perfect Storm
Slide 8: FIGURE 3: CARDIOLOGY CENTER-OF-EXCELLENCE BALANCED SCORECARD STRATEGIC OBJECTIVES BY DIMENSION FINANCIAL PERFORMANCE Achieve profitable growth Improve operating performance PROVIDER OF CHOICE Improve hospitality of services Improve/reinforce image to customer segments INTERNAL PROCESSES Improve clinical innovation Improve business productivity LEADING DRIVER PERFORMANCE MEASUREMENTS LAGGING OUTCOME 6 Length-of-stay vs. best-practice benchmark Payor contract development vs. plan Average total cost per case Case mix adjusted occupancy rate Days to next appointment availability Advertising budget per cardiac bed Customer satisfaction survey Marketing focus group scores $ in cardiology research programs % of first-time clean claims Resource consumption (index vs. benchmark) Days in Accounts Receivable EMPLOYER OF CHOICE Upgrade staff competencies Create climate for action % of cardiology board certified physicians % of staff received Six Sigma training Strategic skill rating Employee satisfaction survey Source: Illustrative example A planning team translates these goals into specific objectives within each of the four performance perspectives (see Figure 3). Outcome measures are then selected to make each objective operational by answering the simple question, “How do we know if we have achieved this objective?” Each objective is then assigned a performance driver measurement to monitor its achievability. In this example, each measure is also given a trend indicator to denote the desired direction, increasing or decreasing. While there is no magic number of measures, research supports a total of 25 to 30 performance indicators per scorecard as ideal from a practical deployment and human cognitive perspective. Measures should be accessible, relevant, and easily understood. They should be balanced between leading and lagging performance indicators and short- and long-term goals. Another criterion for the measure set is balance, such that no single measure outweighs or is improved at the expense of another. The next step in charting the achievement of the business plan is to design and build the performance management system that will manifest the designed scorecard. Kurt Salmon Associates | Catalyst, Summer 2004
Slide 9: The Shipyard Building the Performance Management System Performance management information technology (PMIT) actually encompasses AT THIS STAGE, THE CARDIAC CENTER OF EXCELLENCE Performance much more than the delivery of a performance scorecard. term) and monitoring operational can be strategic (long(real-time) in the type and timeliness of its delivered measures. While management may need to understand occupancy trends to 7 PERFORMANCE SCORECARD IS A TABLE-TOP PLANNING EXERCISE. It is not radically different than dozens of planning frameworks put forth throughout the history of organization management science. The organization must now determine how the performance scorecard will be built and delivered to decision makers in a timely and actionable fashion. Information technology is one component of the solution. Performance management information technology (PMIT) actually encompasses much more than the delivery of a performance scorecard. It can enable a broader performance management system, including the acquisition and management of performance data, assisting with the business planning cycle, operational and capital budgeting, Six Sigma support, and information analysis functionality. This Catalyst will focus on a performance management system comprised of three capabilities: performance monitoring, evaluation, and improvement. PERFORMANCE MONITORING. Like a radar or Doppler plan bed capacity and allocation for the next two years (strategic), it must also know this week’s census and acuity to plan adequate RN coverage for next week (operational). Each type of performance monitoring objective indicates the need for different types of data sources, data management processes, timeliness, and analytical methods for delivering information and actionable knowledge into the hands of decision makers. Certainly strategic monthly, quarterly, and yearly reporting is the primary focus of the BSC. However, steering the organization according to plan is only possible when measures are operational and actionable as well. EVALUATION. Performance monitoring allows manage- ment to identify negative and positive performance events and trends in a timely manner. Management must then conduct root-cause analysis to drill down into layers of performance information detail and isolate contributing factors. The ability to evaluate performance indicates a broader requirement for integrating and normalizing detailed performance data into a single managed performance data resource. The data resource is made readily available for analysis using a variety of decision support tools within an integrated performance management system environment. Decision makers should be able to navigate seamlessly from performance monitoring to evaluation, prepared to take immediate action and make knowledge-based decisions. screen tracks a storm, effective performance monitoring explicitly maps performance measures to the business plan’s strategic objectives, goals, and initiatives and communicates their performance to stakeholders, including Joint Commission on Accreditation of Health Care Organizations (JCAHO), patients, payors, Centers for Medicare and Medicaid Services (CMS), and the community. The BSC report is the primary method of communicating to management actual vs. expected performance. Performance Management Systems | Navigating the Perfect Storm
Slide 10: IMPROVEMENT. Once the underlying cause of a perform- BSC goal of ensuring every workforce member, department, division, and vice president knows how and how well it contributes to corporate strategy achievement. COLLABORATION FUNCTIONALITY allows accountable ance problem is evaluated, management and analysts must redirect operational efforts and improve the underlying process(es) to stay on the course of the business plan. The health care industry is increasingly adopting Six Sigma and other performance improvement tech8 niques and applying them to performance management systems by exploiting the performance data resource, the BSC, and the collection of evaluation and analysis tools. More advanced capabilities include business process modeling and data mining techniques that can model and explain variations and create “if-then” models for improvement interventions. A BROAD SET OF INFORMATION TECHNOLOGY REQUIREMENTS MUST BE MET TO ENABLE THESE THREE CAPABILITIES OF THE PERFORMANCE MANAGEMENT SYSTEM. management to communicate, document, and collaborate as a team when monitoring and evaluating performance trends. There is no longer a need to play phone tag with three department directors to explain a variance to the CEO; an organization can interact directly with the CEO within the environs of the performance management system, with performance data, trends, and management explanations all in one place. DATA MANAGEMENT. Because the goal of the BSC is to create views of the organization that extend beyond financial elements, data regarding clinical care, quality, patient safety, operations, administration, external benchmarks, and competitor market share are also required. Data must be sourced from a wide variety of internal and external information systems and data collection processes. The many disparate information sources — internal and external, electronic and manual — must be managed for the expressed purpose of performance monitoring, evaluation, and improvement. Data must be extracted, integrated, standardized, and cleansed. The manifestation of this data management technology and integrated data resource effort is a corporate performance data warehouse. BUSINESS INTELLIGENCE. The management of an organi- Information technology is needed to acquire performance data, organize it for reporting and analysis, and apply various visualization and analysis tools to the organized performance data. The performance management IT components can be organized into three broad categories of functionality: the BSC, data management, and business intelligence. THE BSC. BSC information technology enables manage- ment to visually monitor and navigate an organization’s business plan and performance measures against targets. The BSC Collaborative is an organization that identifies specific BSC technology functionality and certifies vendors against that list. Key BSC functionality includes: STRATEGY MAPPING OR VISUAL NAVIGATION of busi- zation’s performance data is one side of the coin; the tools, technologies, and methodologies to exploit that data to generate actionable knowledge is the other. A set of what is commonly termed Business Intelligence (BI) tools provides drill-down, Web-based reporting, statistical analysis, business activity monitoring, business process modeling, data mining, data visualization, portal, and dashboard functionality to complement and complete the PMIT environment. ness plan strategies, objectives, goals, and measures. DATA VISUALIZATION, such as performance status icons using stop-lighting (red, yellow, green). DIRECTIONAL ICONS, GAUGES, DIALS, AND OTHER VISUAL CLUES to alert management to growing prob- lem areas. LINE-OF-SIGHT FUNCTIONALITY linking individual staff, and departmental and service line performance scorecards to the corporate business plan. This serves the Kurt Salmon Associates | Catalyst, Summer 2004
Slide 11: Sailing the High Seas PMIT Strategy The strategy and solution set will depend on the realities of the future-state vision MUCH LIKE CLASSIC CORPORATE BUSINESS PLANNING, HEALTH CARE ORGANIZATIONS NEED TO TAKE A CONSIDERED AND STRATEGIC APPROACH TO DEFINING identify current capabilirelative to the organization’s current PMIT environment. ties’ strengths and weaknesses; and evaluate existing applications, skill sets, tools, and processes. The assessment should identify the inhibitors and accelerators to adopting a new performance management system and determine whether the current analytical culture and management skill set are able to exploit access to performance data and analytical tools. STEP 2: The next step is to define a future-state vision and 9 AND DEPLOYING A PERFORMANCE MANAGEMENT SYSTEM AND APPLYING INFORMATION TECHNOLOGY AS A SOLUTION. A three-step PMIT strategy process is recom- mended to assess where the organization is now, where it wants to be, and how it will get there (see Figure 4). STEP 1: The organization assesses the existing perform- ance management system environment relative to best practices and identifies corporate requirements. The goal of the assessment is to identify management requirements with regard to access to performance information; perform a gap analysis of the current environment. Alternative performance management strategies for achieving the future state, assessing relative value propositions, and recommending a preferred strategy to pursue are devised. FIGURE 4: THREE-STEP PMIT STRATEGY PROCESS STEP 1 (Where are we now?) Examine Project Organization Set Project Goals and Objectives Assess Current PMIT Environment Identify Strengths and Weakness Assess PMIT Environment STEP 2 (Where do we want to go?) Define Analytical Processes/ Culture Requirements Define Analytical Requirements Define Data Management Requirements Determine Unmet PMIT Needs (Gaps) Define, Evaluate, and Select PMIT Strategy STEP 3 (How do we get there?) Perform Marketplace Overview Evaluate Technology Solution(s) Select Technology Solution(s) Formulate Budget and Timeline Projections Begin PMIT Implementation Source: KSA methodology Performance Management Systems | Navigating the Perfect Storm
Slide 12: STEP 3: Upon senior leadership’s confirmation of a pre- How far can our existing financial decision support applications take us in pursuing the goals of the BSC? How well does the existing information technology environment support the automated capture of clinical data required for quality and patient safety performance indicators? As these probing questions indicate, the scope of a PMIT strategy and its associated tactical solution(s) can vary widely. The solution may be as simple as a targeted niche BSC product; it may include data warehousing, budgeting, and business planning within an ERP environment; or it may include any solution map in between. The strategy and solution set will depend on the realities of the future-state vision relative to the organization’s current PMIT environment. Upon specification of a PMIT solution scope, assessment of the current PMIT environment, and identification of the gaps between the current environment and the future-state vision, the organization must determine how best to address the gaps and move toward the future-state vision. Based on numerous technology planning and selection projects, KSA has identified three broad PMIT strategies (see Figure 5). BEST-OF-BREED. Allows each entity, service line, and ferred performance management strategy, it is translated into a tactical plan to pursue policy changes; skill set development; business planning calendars; and technology selection, acquisition, and implementation. Performance management and assessment of the current 10 environment will undoubtedly give rise to several challenges for the organization to overcome as it embarks on improving its strategic planning and deployment approach. These challenges include: Holding management accountable for performance. Enabling accountability through performance-based reward and compensation models. Affecting policy and culture changes with respect to corporate information access. Building consensus and standardizing corporate performance metrics across multiple perspectives, entities, and departments. In addition to organizational behavior and cultural challenges, a key PMIT strategy challenge is determining how best to integrate and exploit existing data and analytical solutions with potentially new PMIT components and solutions. Frequently asked PMIT strategy questions include: Are broader requirements for data management and analysis, automating the budget cycle, and integrated business planning required, or is a visual dashboard of performance indicators sufficient? Does our Enterprise Resource Planning (ERP) vendor offer a PMIT solution that can meet our health carespecific requirements? department to determine how best to satisfy each of the three PMIT components with a best-in-class solution for BSC, data management, and business intelligence. BEST-OF-FAMILY. Groups the PMIT components into “functionality families” to be addressed by a smaller set of vendors, reducing cost, support, implementation, and FIGURE 5: THREE BROAD PMIT STRATEGIES BEST-OF-BREED Each PMIT component is satisfied by the “best” niche vendor solution Entity-/department-specific solutions BEST-OF-FAMILY Group PMIT solution components into two “families” of functionality: – Data Management (DM) and Business Intelligence (BI) – The Balanced ScoreCard (BSC) END-TO-END Further group PMIT solution into a single suite of functionality: DM, BI, and BSC Source: KSA methodology Kurt Salmon Associates | Catalyst, Summer 2004
Slide 13: integration challenges. Companies should strive to standardize best-of-family solutions as a single PMIT solution set across the entire organization. The definition of the functionality families can differ based on the realities of an organization’s assessment and the identified gaps in the PMIT environment. One definition could include data management and business intelligence as one family (one vendor) and the BSC as another. The BSC and business intelligence could be yet another family coming from one vendor and data management technology from another. END-TO-END. The perceived benefits of the best-of-family PMIT VENDOR MARKETPLACE Given the scope of an organization’s PMIT approach, and the various possible strategies, many vendors and solutions can be included in an organization’s PMIT solution set. Several vendors’ business intelligence and BSC products can be considered functionality families. Numerous niche vendors specialize in BSC functionality as well. While accredited by the BSC Collaborative, many of these niche solutions require the acquisition and integration of business intelligence and data management tools if such don’t already exist. An organization lacking all three PMIT components can consider a smaller set of end-to-end vendors claiming to offer the components in an ostensibly integrated environment. Figure 6 provides a PMIT marketplace overview based on KSA analysis. It is not an allinclusive depiction of potential vendors, but represents perceived leadership in the PMIT space. 11 strategy can be further expanded to a strategy in which all the PMIT components are supplied by a single integrated solution set from a single vendor. This strategy works best when it is deemed by the organization during the PMIT assessment that none of the three components — the BSC, data management, or business intelligence — are prevalent and/or enjoy a single, consistent strategy and solution set across the organization. FIGURE 6: PERCEIVED PMIT LEADERSHIP VENDOR ACTIVESTRATEGY BUSINESS OBJECTS COGNOS CORVU CRYSTAL DECISION HYPERION INFORMATICA ORACLE PBVIEWS SAS PMIT COMPONENT BSC BI, DM BSC, DM, BI BSC BI, BSC BI, BSC DM DM, BSC, BI BSC BI, DM, BSC BEST-OF-BREED BEST-OF-FAMILY END-TO-END Source: KSA marketplace analysis Performance Management Systems | Navigating the Perfect Storm
Slide 14: Compass Points As the owner of a PMIT solution set, you will embark on the challenging voyage of deploying the policy changes, process redesign, skill set development, and technology implementation to realize the future-state vision. Great attention must be paid to ensuring key success factors are in place and managed within a continuous risk management program. SECURE EXECUTIVE SPONSORSHIP. Senior management must sponsor a project of this magnitude and strategic importance. The performance management system and PMIT must be treated as a strategic and mission-critical initiative owned and sponsored by the CEO or his/her designee, in partnership with the CIO. This project will expose and create numerous political challenges, require significant funding, and likely cause considerable cultural change. Committed and astute executive sponsorship is critical to keeping the project alive, focused, and on course for success. INVOLVE OPERATIONS. The involvement of stakeholders from operations, specifically patient care-related departments, is also critical. The next level of performance improvement will be in patient care, quality, and clinical operations; not finance, human resources, and materials. From strategy through implementation, stakeholders from ambulatory, operating room, clinical, pharmacy, nursing, and senior management should be intimately involved, owning the project and its success. COMMUNICATE. Given the dramatic cultural change and broad scope of the project, constant and consistent com- munication will stoke excitement and adoption of the PMIT environment. Starting with senior management, the “why and how it will affect you” message should spread through the organization through existing communication channels, as well as new ones, such as a performance management newsletter. The BSC is used by more than 60% of Fortune 500 companies to measure performance and align operations with strategies. Strategy is critical to guiding health care organizations through dynamic markets and ever changing competitive environments. Outside competition, regulatory changes, and more sophisticated patient expectations are just some of the factors driving organizational change. Only those organizations prepared to execute strategy and maximize business performance will succeed. Performance evaluation predicated on the BSC helps integrate business and clinical performance at strategic and tactical levels by measuring, disseminating, and analyzing interrelated key performance indicators. This Catalyst reviewed the challenges of devising and deploying an information technology strategy to enable the goals of performance management and measurement in the stormy health care environment. Implementing PMIT within the BSC performance management system can help align an organization’s mission, vision, and strategic plan with its success-defining measures. Using PMIT can also create management tools to evaluate opportunities for improvement and support knowledge-based decision making that will enable organizations to navigate successfully into the 21st century.
Slide 15: We hope you found this Catalyst insightful and actionable. For more information about how KSA can help your organization apply BSC performance management systems and PMIT strategies and solutions to navigate the perfect storm, e-mail perform@kurtsalmon.com.
Slide 16: www.kur tsalmon.com Offices Worldwide