ICU Performance: Managing with Balanced Scorecards

  • K. Shukri
  • F. S. M. Ali


Intensive care units (ICUs) are dynamic organizations with one of the most complex environments of all healthcare facilities. Defining or measuring ICU performance is, therefore, challenging. The meaning, scope, and measurement of performance in health care has evolved and expanded over the past two decades. Some of the most widely used approaches to improving performance in health care have proved inadequate, all the more as, since 2000, healthcare organizations are faced with increasing challenges, including changing demographics, increased customer expectations, increased competition, and intensified governmental pressure, that demand unprecedented levels of change. Meeting these challenges will require healthcare organizations to undergo fundamental changes and to seek new ways to improve performance.


Intensive Care Unit Intensive Care Unit Patient Standard Mortality Ratio Decubitus Ulcer Balance Scorecard 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Garland A (2005) Improving the ICU: Part 1. Chest 127: 2151–2164CrossRefPubMedGoogle Scholar
  2. 2.
    Le Gall JR (2007) Performance of adult intensive care units. Thirty years’ experience. Bull Acad Natl Med 191: 869–877PubMedGoogle Scholar
  3. 3.
    Zimmerman JE (2002) Measuring intensive care unit performance: a way to move forward. Crit Care Med 30: 2149–2150CrossRefPubMedGoogle Scholar
  4. 4.
    Glance TG, Osler TM, Dick A (2002) Rating the quality of intensive care units: is it a function of the intensive care unit scoring system? Crit Care Med 30: 1976–1982CrossRefPubMedGoogle Scholar
  5. 5.
    Bastos PG, Sun X, Wagner DP, Knaus WA, Zimmerman (1996) Application of APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study. Intensive Care Med 22: 564–570CrossRefPubMedGoogle Scholar
  6. 6.
    Moreno R, Metnitz PG, et al (2005) On behalf of the SAPS 3 investigators. SAPS 3-from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31: 1345–1355CrossRefPubMedGoogle Scholar
  7. 7.
    Metnitz PG, Lang T, Vesley H (2000) Ratio of observed to expected mortality is affected by differences in case mix and quality of care. Intensive Care Med 26: 1466–1472CrossRefPubMedGoogle Scholar
  8. 8.
    Joint Commission on Accreditation of Healthcare Oragniztions (2007) ICU measure overview. Available at: www.jointcommision.orgGoogle Scholar
  9. 9.
    Solucient Leadership Institute (2007) Top 100 hospitals. National benchmarks for success 2006. Available at: www.100tophospitals.comGoogle Scholar
  10. 10.
    Thibault GE, Mulley AG, Barnett GO (1980) Medical intensive care: indications, interventions and outcomes. N Engl J Med 302: 938–942PubMedGoogle Scholar
  11. 11.
    Donchin Y, Gopher D, Olin M, et al (1995) A look into the nature and causes of human errors in the intensive care unit. the hostile environment of the intensive care unit. Crit Care Med 23: 294–300CrossRefPubMedGoogle Scholar
  12. 12.
    Buckley MS, Erstad B, Kopp B, Theodorou AA, Priestley G (2007) Direct observation approach for detecting medication errors and adverse drug events in pediatric intensive care unit. Pediatr Crit Care Med 8: 145–152CrossRefPubMedGoogle Scholar
  13. 13.
    Rothschild JM, Landrigan CP, Cronin JW (2005) The critical care safety study: the incidence and nature of adverse events and serious medical errors in intensive care. Crit Care Med 33: 1694–1700CrossRefPubMedGoogle Scholar
  14. 14.
    Wright D, Mackenzie SJ, Buchan I (1991) Critical incidents in intensive care therapy unit. Lancet 338: 676–678CrossRefPubMedGoogle Scholar
  15. 15.
    Giraud T, Dhainaut J, Vaxelaire J (1993) Iatrogenic complications in adult intensive care units, a prospective two center study. Crit Care Med 21: 40–51CrossRefPubMedGoogle Scholar
  16. 16.
    Chalfin DB, Cohen IL, Lambrinos J (1995) The economics of cost effectiveness of critical care med. Intensive Care Med 21: 952–961CrossRefPubMedGoogle Scholar
  17. 17.
    Pronovost PJ, Goeschel C (2005) Improving ICU care: it takes a team. Health Exec 20: 15–22Google Scholar
  18. 18.
    Norris C, Jacobs P, Rapport J, et al (1995) ICU and non-ICU cost per day. Can J Anaesth 42: 192–196CrossRefPubMedGoogle Scholar
  19. 19.
    The leapfrog group (2004) ICU physician staffing fact sheet. Available at: http://www. leapfroggroup. org/media/file/Fact_Sheet_IPS_081104.pdf Accessed Nov 2008Google Scholar
  20. 20.
    Pannirselvam GP, Ferguson LA (2001) A study of the relationships between the Baldrige categories. International Journal of Quality and Reliability Management 18: 14–34CrossRefGoogle Scholar
  21. 21.
    Strack van Schijndel RJ, Burchardi H (2007) Bench-to-bedside review: leadership and conflict management in the intensive care unit. Crit Care 11: 234CrossRefPubMedGoogle Scholar
  22. 22.
    Laporta DP, Burns J, Doig CJ (2005) Bench-to-bedside review: dealing with increased intensive care unit staff turnover: a leadership challenge. Crit Care 9: 454–458CrossRefPubMedGoogle Scholar
  23. 23.
    Pronovost PJ, Berenholtz SM, Goeschel CA (2006) Creating high reliability in health care organizations. Health Serv Res 41: 1599–1617CrossRefPubMedGoogle Scholar
  24. 24.
    Pronosvost P, Needham DM, Waters H, et al (2004) Intensive care unit physician staffing financial modeling of leapfrog standard. Crit Care Med 32: 1247–1253CrossRefGoogle Scholar
  25. 25.
    Hugonnet S, Chevrolet JC, Pittet D (2007) The effect of workload on infection risk in critically ill patients. Crit Care Med 35: 76–81CrossRefPubMedGoogle Scholar
  26. 26.
    American Association of Critical Care Nurses (2005) AACN standards for establishing and sustaining healthy work environments. Available at: Files/HWEStandards/$file/HWEStandards.pdf Accessed Nov 2008Google Scholar
  27. 27.
    Kaplan RS, Norton DP (1992) The balanced scorecard — measures that drive performance. Harv Bus Rev 70: 71–79PubMedGoogle Scholar
  28. 28.
    Meliones J (2000) Saving money, saving lives. Harv Bus Rev 78: 57–62PubMedGoogle Scholar
  29. 29.
    Curtright JW, Stolp-Smith SC, Edell ES (2000) Strategic performance management: development of a performance measurement system at the Mayo Clinic. J Health Manag 45: 58–68Google Scholar
  30. 30.
    Baker GR, Pink GH (1995) A balanced scorecard for Canadian hospitals. Healthc Manage Forum 8: 7–21PubMedCrossRefGoogle Scholar
  31. 31.
    Chen XY, Yamauchi K, Kato K, Nishimura A, Ito K (2006) Using the balanced scorecard to measure Chinese and Japanese hospital performance. Int J Health Care Qual Assur 19: 339–350CrossRefGoogle Scholar
  32. 32.
    Hong Y, Hwang KJ, Kim MJ, Park CG (2008) [Balanced scorecard for performance measurement of a nursing organization in a Korean hospital] Taehan Kanho Hakhoe Chi 38: 45–54PubMedGoogle Scholar
  33. 33.
    Huang SH, Chen PL, Yang MC, Chang WY, Lee HJ (2004) Using a balanced scorecard to improve the performance of an emergency department. Nurs Econ 22: 140–146PubMedGoogle Scholar
  34. 34.
    Wachtel TL, Hartford CE, Hughes JA (1999) Building a balanced scorecard for a burn center. Burns 25: 431–437CrossRefPubMedGoogle Scholar
  35. 35.
    Studer Q (2003) Hardwiring Excellence. Fire Starter Publishing, Gulf BreezeGoogle Scholar
  36. 36.
    Kaplan RS, Norton DP (1996) The Balanced Scorecard: Translating Strategy into Action. Harvard Business School Press, BostonGoogle Scholar
  37. 37.
    Berenholtz SM, Pronovost PJ, Ngo K (2007) Developing quality measures for sepsis care in the ICU. Jt Comm J Qual Patient Saf 33: 559–568PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • K. Shukri
    • 1
  • F. S. M. Ali
    • 2
  1. 1.Department of Critical CareKing Fahad Specialist HospitalDammamSaudi Arabia
  2. 2.Department of Emergency MedicineKing Fahad Specialist HospitalDammamSaudi Arabia

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