ROI Case File No.260 | 'North American Healthcare Company's Transformation'

Chapter One: Conventional Management Reaching Its Limits—The Danger of Pursuing Numbers Alone

The week following the resolution of NextWave Telecom's AARRR case, a consultation arrived from North America regarding healthcare service company management metrics. This case, the memorable final episode of the twentieth volume "Integration of Practice"—the 260th episode—concerned the challenge of breaking away from finance-focused management to achieve balanced growth.

"Detective, we provide healthcare services in Chicago, but our pursuit of short-term profits has led to serious problems: employee exhaustion, declining patient satisfaction, and medical quality issues. We're meeting financial metrics, but the organization is breaking down."

David Thompson, CEO of MediCare Solutions from Chicago, visited 221B Baker Street with a grave expression. In his hands, he held favorable financial reports alongside deteriorating employee satisfaction and patient evaluation data—a stark contrast.

"We're a company providing home healthcare and visiting nurse services across the Midwest. We've responded to shareholder profit demands through thorough efficiency. However, pursuing numbers has lost us the organization's essential strength."

MediCare Solutions' Financial-Organizational Disconnect: - Founded: 2012 (healthcare services company) - Service Area: 5 Midwest states, 28 locations - Annual Revenue: ¥42 billion (steady growth) - Operating Profit Margin: 12% (above industry average) - However... Employee satisfaction: 2.8/5, Turnover rate: 35% annually

The numbers appeared favorable on the surface. However, deep crisis awareness was etched on David's face.

"The problem is that to achieve quarterly profit targets, we've cut long-term investments, reduced staff, and eliminated training. Financial metrics are met, but the field is exhausted and medical quality is declining."

Adverse Effects of Finance-Focused Management: - Cost reduction pressure: Increased patients per nurse (quantity over quality) - Cut education investment: Halved training time (lost skill improvement opportunities) - Deferred facility investment: Postponed medical equipment updates (field inefficiency) - Short-term profit priority: Neglected long-term business foundation strengthening - Result: 35% employee turnover, patient complaints +45% year-over-year

"We're achieving 'numbers' but have lost 'sustainability.' We'll collapse at this rate."

Chapter Two: BSC Implementation Background—Balance of Four Perspectives

"Mr. Thompson, what is the current composition of management metrics?"

Holmes inquired quietly.

David explained painfully.

"Basically only financial metrics. Revenue, operating profit margin, ROI, cash flow. Meeting these targets is everything—employee and patient satisfaction, medical quality, and future investment are treated as 'costs.'"

Current Management Metrics (Finance-Focused):

What's Measured: - Revenue growth rate (quarterly) - Operating profit margin (monthly) - Revenue per patient (weekly) - Cost reduction rate (monthly)

What's Not Measured: - Employee growth and satisfaction - Patient medical outcomes and satisfaction - Medical quality and safety - Future investment and innovation

Result: Pursuing only "visible numbers," collapsing "invisible value"

I noted the one-dimensionality of management metrics.

"Finance is results. Without measuring the factors producing those results, sustainable growth is impossible."

David responded with a serious expression.

"Exactly. But what should we measure and how to achieve balanced management?"

⬜️ ChatGPT | Catalyst of Conception

"Financial, Customer, Internal Processes, Learning & Growth. Four perspectives support the organization."

🟧 Claude | Alchemist of Narrative

"Pursue short-term numbers or nurture long-term value? BSC is the compass for balance."

🟦 Gemini | Compass of Reason

"The Balanced Scorecard visualizes strategy. Connecting goals through cause and effect."

The three members began their analysis. Gemini deployed a "Healthcare Industry-Specific BSC" framework on the whiteboard.

Balanced Scorecard's Four Perspectives: - Financial Perspective - Value to shareholders (revenue, profit, investment return) - Customer Perspective - Value to patients (satisfaction, medical outcomes, trust) - Internal Process Perspective - Process quality and efficiency (quality, safety, efficiency) - Learning & Growth Perspective - Organizational capability (people, technology, culture)

"Mr. Thompson, let's design MediCare's management balanced across four perspectives."

Chapter Three: Multidimensional Evaluation Axes—Metrics Connected by Cause and Effect

MediCare Solutions' BSC Design:

Phase 1: Strategy Map Creation (2 months)

Connecting four perspectives through cause and effect:

Learning & Growth Perspective (Foundation): - Employee satisfaction improvement: Target 2.8 → 4.0 - Skill development: Double annual training hours - Organizational culture: Permeate patient-centered values

↓ This Creates ↓

Internal Process Perspective: - Medical quality improvement: 50% reduction in medical accidents - Efficiency improvement: Standardize and digitalize business processes - Innovation: New service development

↓ This Creates ↓

Customer (Patient) Perspective: - Patient satisfaction: 3.5 → 4.5 - Medical outcomes: Improve health improvement rate - Build trust: Improve patient recommendation score (NPS)

↓ This Creates ↓

Financial Perspective (Result): - Sustainable revenue growth: Quality growth - Maintain profit margin: Both efficiency and value enhancement - Long-term value: Sustainable corporate value improvement

Phase 2: Specific Metric Setting for Each Perspective

Learning & Growth Perspective: - Employee satisfaction: Measured quarterly survey - Turnover rate: 35% → 15% or below - Training hours: Annual average 40 hours → 80 hours - Employee skill level: 5-point scale average 3.5 → 4.2

Internal Process Perspective: - Medical accident rate: 8 cases/month → 4 or below - Time per patient visit: Ensure appropriate time (30 min → 45 min) - Documentation time: 50% reduction through digitalization - Process standardization rate: 80% of all services standardized

Customer (Patient) Perspective: - Patient satisfaction: 3.5 → 4.5 - Health improvement rate: 60% → 75% - Complaint count: 45 cases/month → 15 or below - Patient recommendation (NPS): Begin measurement, target +40

Financial Perspective: - Revenue growth rate: Maintain +12% annually - Operating profit margin: Maintain 12% while achieving quality growth - Investment ROI: Measure effects of education and facility investment - Shareholder value: Sustainable corporate value improvement

Chapter Four: Achieving Sustainable Growth—Power Created by Balance

Results After 12 Months:

Learning & Growth Perspective Improvements: - Employee satisfaction: 2.8 → 4.1 (major improvement) - Turnover rate: 35% → 16% (less than half) - Training hours: Annual 40 hours → 85 hours (more than doubled) - Employee skills: 3.5 → 4.3 (improved)

Internal Process Improvements: - Medical accidents: 8 cases/month → 3 cases (62% reduction) - Visit time: 30 min → 45 min (quality improvement) - Documentation: 55% reduction through digitalization (efficiency) - Standardization: 85% completed (quality stabilization)

Customer (Patient) Value Enhancement: - Patient satisfaction: 3.5 → 4.6 (major improvement) - Health improvement: 60% → 78% (improved medical outcomes) - Complaints: 45 cases/month → 12 cases (73% reduction) - NPS: +42 (high recommendation score)

Sustainable Financial Growth: - Revenue growth rate: +12% maintained (quality growth) - Operating profit margin: 12% → 14% (efficiency and value enhancement) - Investment ROI: Education and facility investment contributed to revenue - Shareholder value: Enhanced evaluation through sustainable growth

Proven Cause and Effect:

Employee satisfaction improvement → Turnover reduction, skill improvement ↓ Medical quality improvement, efficiency improvement ↓ Patient satisfaction improvement, medical outcome improvement ↓ Revenue growth, profit margin improvement, corporate value enhancement

Employee Voices:

Visiting Nurse (32): "Before, we were running around for numbers. Now we have time to face patients and can provide true nursing care."

Manager (45): "Before BSC, only 'cost reduction' orders. Now we can discuss 'value creation.' Goals are clear and fulfilling."

Chapter Five: The Detective's BSC Diagnosis—Balance Creates Power

Holmes compiled his comprehensive analysis.

"Mr. Thompson, the Balanced Scorecard's essence is 'strategy visualization and cause-effect clarification.' Finance is result; by measuring and managing the factors producing those results across four perspectives, sustainable growth becomes possible. Pursue short-term numbers or nurture long-term value? BSC is the compass for that balance."

Final Report After 24 Months:

MediCare Solutions became an industry benchmark company.

Final Results: - Annual revenue: ¥42B → ¥58B (38% growth) - Operating profit margin: 12% → 16% (both quality and quantity) - Employee satisfaction: 2.8 → 4.3 (top-class) - Patient satisfaction: 3.5 → 4.7 (industry-leading level)

The letter from David contained deep gratitude:

"Through BSC, we were reborn from a 'short-term profit-seeking company' to a 'sustainable value-creating company.' Most important was nurturing not just finance but customers, processes, and people in balance. Now employees work with pride, patients trust us, and consequently finance improves. Balance creates true power."

The Detective's Perspective—Volume Twenty "Integration of Practice" Concludes

That evening, I contemplated the importance of balance.

The Balanced Scorecard's true value lies in balancing short and long term, results and causes, visible and invisible value. Pursuing only finance exhausts the organization; focusing only on customers loses profit. Nurturing four perspectives in balance creates sustainable growth.

Volume Twenty "Integration of Practice" depicted ten stories of establishing analytical methods learned in Volume Nineteen as daily practice. KPT habituation, PEST environmental understanding, RFM customer understanding, Design Thinking empathy, Blue Ocean creation, OODA responsiveness, NPS true feeling measurement, Empathy Map inner understanding, AARRR growth systematization, and BSC balanced management.

When these practices integrate, organizations truly learn, grow, and become living entities creating sustainable value.

"Analysis is the beginning; practice is everything. And the accumulation of practice transforms organizations."

Volume Twenty concludes here. The next volume will begin a journey toward even higher ground.

"Balance isn't static. It's dynamic harmony. BSC is the management compass to maintain that harmony."—From the Detective's Notes

— Volume Twenty "Integration of Practice" Complete —