Let dashboards lead you to success

When looking toward the road ahead, drivers rely on their vehicles' dashboards for guidance. The myriad of dials, gauges, and digital displays help them travel safely and swiftly.

The speed and nimbleness with which behavioral healthcare managers must navigate today's market makes a corporate dashboard equally useful for driving performance improvement.

Dashboards: Tools for accountability

The term dashboard, sometimes used interchangeably with key performance indicators or scorecard, has gained wide acceptance as a systematized approach to accountability and, by extension, performance improvement. “You can say that your organization is ‘good.’ Can you prove it?” asks Ron Brown, executive director for Three Springs of North Carolina in Pittsboro, NC. “Dashboards enable our organization to measure a client's improvement over time and monitor client and employee satisfaction. Our staff and other stakeholders, including referral sources, want to see the progress our clients are making.”

Collecting and analyzing data allows managers to quickly recognize trends, leverage stellar performance, and shift support to programs that are not achieving their objectives. “Today's environment demands accountability. Performance indicators-or dashboards-transform data into actionable information,” says June DiPolito, executive director of Pineland Community Services of Statesboro, GA.

The uses for the information are as numerous as the various measures employed. In addition to addressing pressing matters identified in an organization's financial health or client outcomes, the data can help spur conversations regarding how to “support a struggling department, reward employees who are excelling, identify future leaders within the organization who might benefit from focused mentoring programs, or capitalize on organizational strengths to be used for future RFP (request for proposal) responses,” says Bontiea Goss, executive director of programs and services for Alternative Opportunities of Springfield, MO. “Establishing carefully constructed dashboard measures can add integrity to your management process by helping management understand benchmarked performance. The level of subjectivity or arbitrary nature of decisions is lessened.”

Figure 1. Dashboard home page. From this page, users may select a category and access graphs or drilldowns of more detailed data.

Many organizations begin with financial indicators for their dashboards, including margin, day's cash on hand, receivable base, and debt/leverage ratios, and then expand to review other fiscal indicators such as billing, census, admissions, discharges, and staff productivity. Traditionally, this type of information has been part of the reports submitted to boards of directors and thus provides a good platform for exploring other topics such as quality measures, clinical factors, human relations, and risk management.

Risk management dashboards report risk incidents that might include “the number and type of worker compensation incidents and critical program incidents, such as medication errors or consumer deaths,” says Tony Zipple, CEO of Chicago-based Thresholds.

Quality dashboards continually grow in their relevance. “We use evidence-based fidelity scores, which include items such as illness management recovery, supported employment, integrated disorder treatment, and number of psychiatric hospitalizations,” Zipple adds.

Many human resources dashboards have significantly expanded beyond measuring turnover rate, now emphasizing factors like cultural diversity. “Over the past seven years, our CEO and board have made a commitment to building a more culturally diverse organization,” says Penny Free, executive vice president of TERROS of Phoenix, AZ. “We include a diversity dashboard that tracks the ethnicity of our staff and compares it to the ethnicity of persons served. The purpose is to use this information to continually improve the balance between the two.”

Indeed, cultural nuances can be uncovered in the data. “Outcome data are perhaps most interesting for the questions they raise. For instance, we suspected and confirmed that our effectiveness is different for different tribal referents,” says June O'Brien, director of the Northwest Indian Treatment Center of Elma, WA. “There are obvious access differences between large, rural reservations and more urban contexts, but there are also differences in the historic trauma of different tribal communities, as well as current pressures. These differences and pressures have implications for more targeted treatment and aftercare support. As a result, we wrote grants to strengthen and expand our approach to treatment, direct more comprehensive data collection, and tailor aftercare efforts in the home community of the referents and alumni.”

Figure 2. No Show graph. When a user selects the No Shows category from the dashboard home page, he/she can access detailed data, such as the graph above which tracks cancelations by client, staff, or no shows over the course of a year. Notice that the number of no shows has increased significantly from May to June. “Drilling down” further into this data allows the user to investigate underlying causes.

O'Brien continues, “For us, examining the outcome data raises questions about trends suggested, but not directly reflected, in the data. We use the same process in other areas, including revenue trends. We can clearly see what the data says, but there are other subliminal messages.”

Figure 3. An example of a drilldown that provides additional insight. This chart shows no shows/cancelations for May compared to June by program. This drilldown chart allows the user to determine that the bulk of the increase in no shows occurred in program 1101.

Set realistic objectives and create buy-in

Implementing a dashboard starts with identifying information to be collected and the indicators to represent this information. Successful practitioners caution about becoming overly ambitious with the launch of a dashboard, which should be closely tied to the organization's mission and objectives. Free suggests, “Form a small internal group to organize the process. Try not to complicate what you are communicating and remember to focus on the vital few measures. You can easily be awed by the availability of a large amount of information, but consider what is most important, as opposed to all of the measurement possibilities. Know what the purposes of your dashboards are.”

Creating buy-in for the dashboard begins with representation from all areas affected by the areas of an indicator. “I initially had a hard time convincing our staff members that dashboards were going to be useful,” says Brown. “I did not get their attention until I began measuring how our clients were improving throughout the course of their treatment. When we began to measure the clients' positive changes and the staff's role in making these changes, I got the staff's attention. This buy-in led to other areas that the staff wanted to measure.”

Zipple agrees: “Cascading sponsorship is important in building a dashboard. Start by looking from the bottom up in your organization. Consumers, clinicians, and the persons you serve all have critical insights into how you manage your organization. Be sure to examine the data collected to assure measurable and actionable areas, the relative ease of collection, and the visual presentation of the data. The graphical representation of information makes it easier for management and staff to review and understand.”

Constructive use of data maintains integrity

“The use of dashboards has to be positive if you want to enjoy their full benefit,” advises Goss. “If the data are used to reprimand, there is no incentive to report accurate information. Our organization believes in a strength-based approach with the persons we serve, as well as with our employees and managers. We use the information gathered from dashboards to improve our clinics so they can provide better services.”

DiPolito reports, “Years ago, we noticed an increase in our AMA (against medical advice) rate within our residential clinical services group. Our dashboard measures helped us identify and ultimately correct this clinical issue.”

Education and accreditation support dashboards

All measures have linkages throughout the organization, and should be considered as indicators requiring further exploration and understanding. “Education about our corporate dashboards is critical for their effectiveness,” Free says. “We use these measures as an excellent springboard for further discovery. We see if decisions need to be made or conversations scheduled to further what we see in the dashboards.”

“Dashboard management serves as an important diagnostic to pinpoint areas for further investigation and possible action,” Zipple notes. “We found that accreditation helps organizations support these efforts. A strong and consistent focus on quality improvement enables a readiness for change. Accreditation provides a structure to encourage an ongoing effort to improve and sustain organizational quality over time.”

Build referrals and funding

From a long-term perspective, dashboard measures can be key to planning efforts to grow referrals and funding. Identifying service requirements and matching offerings to strengths identified in the data can significantly affect future organizational success. “We use our indicators to educate legislators and other stakeholders. If you aren't involved in a dialogue on where agencies are going, you will be very vulnerable in the future,” Goss predicts.

“We also use indicators to help educate our staff about policies and procedures that would be more effective and to help them understand why we want to grow in a certain area,” Goss continues. “For instance, if we are measuring employment obtained for the persons served and the numbers are declining, we need to look at what state funding sources are available to bolster these efforts. Having the numbers helps our executives make decisions in a more confident way. If they don't have concrete data, it will be a difficult task to convince legislative representatives to support additional funding allocations.”

Figure 4. A drilldown into program 1101. This allows the user to determine which staff members have contributed most to the increase in no shows. This could be an opportunity to discuss with those staff what has caused the change. Another common drilldown for no shows is to slice by client, which often allows identification of repeat offenders for no shows. These steps can lead to process improvements (such as calling ahead to confirm appointments or taking extra measures to confirm with repeat no show offenders).

Glyn Thomas, PhD, is executive director of Satilla Community Services and chair of the Cost Control and Benchmarking Committee for the Georgia Association of Community Service Boards. GACSB collects quarterly and annual benchmarking data from 25 agencies the association represents and shares that data with a legislative educator and the association's Public Policy and Information Committee. “We provide factual information on issues that might be of interest to the legislative process,” says Thomas. “Our data identify the best practices employed by our member agencies. Despite the budget cuts that have occurred in the past three years, GACSB's members have had success in making their budget dollars go further. Nonetheless, greater demand and reduced funding is forcing some providers into the red.”

Dashboard data require human interpretation

As with any system under review, dashboard measures are “only as good as the people who are given the responsibility of working with them. From selecting the measures to data collection and analysis, the adage of ‘garbage in, garbage out’ can apply,” Brown cautions. “The importance of working with a dedicated team to maintain the integrity of the reporting process is vital.”

“Dashboards help preserve fidelity to the evidence-based interventions and outcomes that we strive for as an organization,” Zipple adds. “The data identify the work being done and provide a trendable measurement that can be followed over time and used for quality improvement.”

Thomas concludes, “From a trending perspective, we see a rising number of people being served, and they are using an increasing number of services. The data we gather and interpret help us work more effectively and efficiently.”

Just as a car needs a driver at the wheel, a corporate dashboard needs skilled people to read its signs and help steer the organization along the road to success.

Nikki Migas, managing director of the Behavioral Health and the Child and Youth Services customer service units of CARF International, has more than 35 years of experience developing and administering behavioral health and other human services programs. Nikki has a background in social work and earned a master's degree in public administration. Nikki was a CARF surveyor for 10 years, and she served on several CARF National Advisory Committees. Behavioral Healthcare 2010 February;30(2):12-15