• John Proctor, Peter Hall, and Janet Carr.
• Team Health, 104 East Park Drive, Suite 303, Nashville, TN 37027, USA. jhproctor@comcast.net
• Emerg. Med. Clin. North Am. 2004 Feb 1;22(1):19-45.

AbstractToday's EPOs and their physicians face an array of daunting challenges. Falling reimbursement, rising malpractice costs. ED and hospital crowding,and demands for improving ED efficiency and patient satisfaction all contribute to the challenging and sometimes threatening environment of EM practice. The EP involved in a busy and often hectic ED shift may feel unduly and unnecessarily distracted when required to continuously acknowledge and address the business aspect of the practice. Nevertheless,regardless of the size and structure, fiscal viability ultimately determines the EPO's ability to continue to offer access to care. This article contends that a comprehensive business strategy drives superior financial performance and supports the organization's mission. The business strategy must identify financial and non-financial determinants of the EPO's success and provide a mechanism for understanding how the organization's resources are converted to value for customers. The section offers a framework for developing this strategy, for identifying possible gaps or deficiencies, and for measuring and monitoring progress in achieving strategic objectives and ultimately, the EPO's mission. The importance of the mission and the dynamic EM environment require that the strategy development process be more than an annual exercise for the leadership of the organization. Though key leaders in any size EPO--set the course for the organization, the entire organization must be aware and understand the strategy before they commit themselves and adopt actions and behaviors that promote it. The model presented here provides a graphic display that lends itself well to consistent communication of a comprehensive strategy in a concise way throughout the organization.Furthermore, the balance of the model, across four perspectives, recognizes the value of balanced organizational objectives and lends itself well to the creation of a measurement system that supports cause and effect relation-ships through leading and lagging indicators. This can prevent the imposition of unproven, arbitrary metrics and expectations.EPOs that expend the time and resources required to develop and implement a comprehensive, well balanced strategy make a long-term investment in their patients and themselves. EPOs that go on to develop credible, efficient measurement systems are not only able to drive more commitment and accountability in the organization, they also have a competitive advantage. They can demonstrate performance history and targeted future performance to differentiate themselves from competitors and to stem efforts to impose unbalanced metrics that do not serve well the hospital, the EPO, and ultimately, patients. The power of such measurement systems, internal and external to the organization, strongly point to the need for consistently defined measures across the industry. Ultimately when faced with changes in the environment,the entire industry will be better equipped to respond in specific ways and to communicate its progress to communities or government authorities.

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