In their April 2005 review of the Fund's institutional growth and development over the preceding five years, management and board members agreed that while the Fund already had in place a variety of performance measures, a scorecard comprising a comprehensive set of measures would help frame the foundation's mission and strategy. Members agreed such an instrument could serve the institution well in the following respects: by further clarifying strategies and improving their articulation within the foundation; by providing performance feedback more regularly and more efficiently; by identifying any significant measurement gaps; by highlighting any weaknesses in operations and institutional capacities; and through the use of "stretch targets," by ensuring the foundation's continued creativity and vitality. Recognizing that the scorecard
could be helpful in tracking the impact of shifts in the foundation's focus (such as the recent launch of the Commission on a High Performance Health System), the Fund's directors argued the measures should be dynamic, changing as the Fund's priorities changed.
In keeping with the Kaplan-Norton framework, the Fund's scorecard measures the foundation's performance from four perspectives: finances, customers (the Fund's audience), internal business processes, and organizational learning and growth capacities. Central to the development of the performance scorecard are the following statements of the Fund's overall goal and its strategic objectives in each of these areas.
 | Fund Overall Goal: To be a leading U.S. foundation helping to move the U.S. toward a high performance health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, minority Americans, young children, and elderly adults. |
| Financial Strategic Objective: To maintain a stable (inflation-adjusted) endowment for advancing the Fund's mission and carrying out its value-added approach to grantmaking. |
| Audience Strategic Objective: To be regarded by health care policymakers, influential health care leaders, researchers, and the major media as a reliable, unbiased, and useful source of information on health policy debates and an effective change agent for improving health system performance. |
| Internal Processes Strategic Objective: To generate and communicate efficiently and innovatively new, timely, useful, and unique information for informing health policy debates and promoting a high performance health system. |
| Organizational Capacities for Learning and Growth Strategic Objective: Under the oversight of a highly accountable board of directors, to recruit, retain, motivate, and empower professional staff uniquely qualified for adding value to the work of grantees and communicating results of the Fund's work to influential audiences. |
The Fund's scorecard has a mix of outcome and "performance-driver" measures for each of the four perspectives. Outcome measures tend to be lagging indicators focused on the strategy's ultimate objectives and whether efforts are leading cumulatively to desirable results. Performance-driver measures are leading indicators that signal the extent to which the foundation has in place strategies and systems to achieve objectives over the long-term.
