Academic journal article Australian Health Review

Balancing the Balanced Scorecard for a New Zealand Mental Health Service

Academic journal article Australian Health Review

Balancing the Balanced Scorecard for a New Zealand Mental Health Service

Article excerpt


Given the high prevalence of mental disorders, there is a need to evaluate mental health services to ensure they are efficient, effective, responsive and accessible. One method that is being used is the "balanced scorecard" which uses performance indicators in four quadrants to assess various dimensions of service provision. This case study describes the steps taken by a New Zealand mental health service to improve service management through greater use of key performance indicators in relation to preset targets using this approach.

Aust Health Rev 2006: 30(2): 174-180

PERFORMANCE MANAGEMENT is defined as achieving objectives by control, and thus requires a systemic approach to exercising control over processes and activities within organisations to achieve some preset purpose. Purpose, effectiveness and efficiency lie at the heart of the task of control within an organisation.1 In 2000, New Zealand adopted a performance management framework for its publicly owned hospitals and affiliated services based on the "balanced scorecard" approach first disseminated by Kaplan and Norton.2 These services are governed and run as part of Crown entities known as District Health Boards (DHBs) and referred to as "provider arms". The scale and importance of the activities of the provider arms, and the existence of semi-independent governance arrangements (a sizeable minority of the Board are publicly elected every three years) means that a transparent approach to monitoring and comparing the performance of provider arms is important to the public of New Zealand.

The ideal balanced scorecard is a carefully selected set of quantifiable indicators chosen to operationalise organisational strategy. The original Kaplan and Norton model proposed that the most important measures of performance could be categorised under four headings: innovation and learning, customer satisfaction, internal processes, and finance. Selecting quantifiable indicators allows internal monitoring of improvement (or deterioration) over time, as well as between-organisation benchmarking and development of best practice across a sector. A set of indicators within the balanced scorecard model can be a powerful tool for health care improvement.

Mental health is one area of health that is poorly understood by the general public, and those who suffer mental ill-health are likely to be subjected to stigmatising and discriminating attitudes. Although large scale anti-discrimination campaigns such as "Like Minds, Like Mine"3 in New Zealand, and "beyondblue" in Australia4,5 are having positive effects on the identification and management of mental disorders, much work remains to be done to reach a point where those with disorders do not experience social exclusion and remain productive members of their community. Moving towards this goal requires communities that accept that mental health care is effective and efficient. This requires evidence of optimal service delivery that relies on robust information from services and key performance indicators within a monitoring framework. With this in mind, one mental health service in New Zealand decided to develop a set of indicators using the balanced scorecard approach to guide service improvement.


During 2005, the initial New Zealand balanced scorecard adopted in 2000 was reviewed by the central policy agency, the Ministry of Health, to determine whether the indicators were still meaningful, and whether there were additional indicators that should be added. While this scorecard (both pre and post review) has merit, the indicators were more orientated to medical and surgical areas, and organisation-wide financial performance (Box 1). Our DHB provider arm mental health services in New Zealand wanted to have a way of monitoring, and potentially comparing, performance with indicators that were relevant to the provision of mental health care and accepted and understood by staff. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.