A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic

Abstract

Background The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. Aim This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. Methods This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). Results There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. Conclusion This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

Assessing Patient Experience and Attitude: BSC-PATIENT Development, Translation, and Psychometric Evaluation—A Cross-Sectional Study

“…In 1992, Norton and Kaplan proposed the initial design of the balanced scorecard (BSC), which incorporated four perspectives: financial, customer, internal process, and knowledge and growth [ 11 ]. In some previous implementations of the BSC, the last perspective was also termed the learning, innovation, technology and development perspective [ 12 ].…”

“…One implementation at HCO in Afghanistan [ 20 ] created the community scorecard (CSC) to include the community in the assessment of the BSC. However, none of the studies included patients in the process of evaluating BSC [ 12 , 19 , 21 ]. Involvement of patients in this process could result in even higher levels of patient satisfaction.…”

“…In contrast to other performance evaluation (PE) tools, which primarily focus on analyzing the internal perspective, the BSC is regarded as a comprehensive approach for PE, as it involves the analysis of six perspectives [ 12 ]. For that, BSC implementations utilized different sources to conduct the PE of HCOs [ 12 , 19 ], including hospital records, patient satisfaction questionnaires, patient and HCW interviews, and observations. Additionally, BSC reviews [ 12 , 19 ] showed that only a few BSC implementations utilized validated scales to evaluate patient satisfaction, such as the Press Ganey questionnaires [ 22 , 23 ].…”

“…For that, BSC implementations utilized different sources to conduct the PE of HCOs [ 12 , 19 ], including hospital records, patient satisfaction questionnaires, patient and HCW interviews, and observations. Additionally, BSC reviews [ 12 , 19 ] showed that only a few BSC implementations utilized validated scales to evaluate patient satisfaction, such as the Press Ganey questionnaires [ 22 , 23 ]. The patient satisfaction perspective is important since patients represent the hospitals’ end receivers of health care services.…”

“…It is not sufficient to perform the PE of HCO based on manager and hospital records only; a focus on EoP among the selection of the KPIs at HCO was recommended [ 24 ]. However, BSC reviews referred to the lack of patient and family member involvement in the evaluation process of BSC [ 12 , 19 , 21 , 27 ].…”