Strategic management of an electronic patient record project using the balanced scorecard.

Effective performance measurement links goals to information. It is an integral part of the management process.1, 2 Organizations have different approaches to providing their management teams with information, ranging from aggregating reports derived from operational systems to explicitly defining a set of key indicators about which data is collected and periodically distributed. Typically, in the latter approach, the emphasis is on standard financial and quality management data defined by corporate staff in those areas.3 This provides large quantities of useful data, but fails to provide assistance to managers in thinking through their real information needs. Ironically, an excess of data overloads rather than enlightens managers. The scarce organizational resource is not information, it is organizational attention—the allocation of information processing capability to a defined issue or agenda.4 Organizational attention is the fundamental constraint in achieving objectives.5 What managers need is the right strategic information at the right time that can focus organizational attention on agendas linked to strategies. The critical success factor (CSF) methodology addresses this shortcoming. CSFs are defined as the limited number of areas in which satisfactory results will ensure successful competitive performance. In the CSF methodology, management teams define industry CSFs, then corporate CSFs, and then CSFs for each subsystem of the organization, down to the individual manager level.6 The balanced scorecard methodology builds on the CSF concept of a limited, coherent set of performance measures related to strategic objectives, and adds the concept of balance among indicators. The balanced scorecard framework presents a management team with four different perspectives from