Balanced Scorecard for performance assessment in healthcare settings: a review of literature

Abstract

Background The Balanced-Scorecard (BSC) is a management tool developed in the early 1990s to balance the impact of financial and non-financial parameters and analyse the organisational performance in private companies according to four determinants. The original BSC has spread to different sectors in the last decades, including healthcare services, in numerous amended versions. The aim of our project was to identify potential indicators of BSC for performance evaluation in general hospitals. Methods We performed a systematic review of literature on Pubmed and Web of Science using the search string “balanced scorecard AND healthcare AND indicators”. We found 102 papers; 80 papers were removed for irrelevance, absence of full text or performance indicators. We only considered articles that followed the classic structure of BSC (Customer, Internal Processes, Financial, and Learning and Growth). The indicators listed in them were classified according to the four determinants of organisational performance. Results Eight articles out of 22 followed the classic structure of the BSC. The most represented category was Internal Processes (59 indicators), followed by Learning and Growth (52), Customer (40) and Financial (33). The number of common/overlapping indicators was low (5 for Internal Processes and 4 for the three other categories). Conclusions While BSC has spread to different settings, the list of indicators used in the classic four determinants for performance evaluation is heterogeneous. While common points can be identified between indicators, our review highlighted that every BSC is developed in a unique way which makes it difficult to identify a general framework adaptable to different hospital settings. Key messages The use of the Balanced Scorecard as management tool has spread to healthcare settings in the last decade. Indicators in BSC for healthcare settings are heterogeneous and only a limited number follow the standard structure of BSC.

The dynamic use of a balanced scorecard in an Italian public hospital

“…report an improvement of decision‐making processes among all the actors that participate in the design process. Inamdar and Kaplan 13 and Gordon 12 describe voluntary initiatives of BSC implementation in which measures give executives and strategic units' managers an effective tool for decision‐making and strategy implementation 25,46 . Finally, two studies mention this type of use in terms of expected use 5…”

“…According to Henri, 10 top managers use performance measurement systems for monitoring when they should provide feedback and communicate with multiple stakeholders. Performance measures 24 , 25 populate reporting documents and top managers promote diagnostic control 26 through the system. In addition, when top managers send priority messages throughout the organization, the system could be used more interactively, 26 focussing attention on specific objectives and measures ( attention focussing use ).…”

“…Inamdar and Kaplan 13 and Gordon 12 describe voluntary initiatives of BSC implementation in which measures give executives and strategic units' managers an effective tool for decision-making and strategy implementation. 25,46 Finally, two studies mention this type of use in terms of expected use. 5 The IUH results signal a further point of attention.…”

Staff perceptions of organisational performance measurement implementation in a health charity

“…2 This in turn supports the realisation of sustainable competitive advantage. [5][6][7][8][9] Whereas program evaluations assess singular, point in time, activities within organisations, OPM enables assessment of the full spectrum of capability to achieve their potential and organisational purpose. 6,8 As described in recent publications, non-acute health charities are both not-for-profit organisations and health service providers, 2,10 and despite broad service scopes, share a number of common governance and service similarities.…”

Action Implementation Model for Organisational Performance Measurement in Non-Acute Health Charities

“…There is a dearth of peer-review literature relating to OPM and non-acute health charities and it appears such organisations under-value, under-utilise or under-report OPM Soysa et al, 2016;Laamanen et al, 2006). NFPs face escalating stakeholder concerns regarding organisational effectiveness, excellence and accountability (Seaman & Young, 2018;Clancey & Westcott, 2017;Hyndman & McConville, 2018;Lecy et al, 2010) and this sector's limited use of OPM and lack of public reporting requires consideration, especially as OPM enables organisational excellence (Bellante et al, 2017;Aboramadan & Borgonovi, 2016;Carneiro-da-Cunha et al, 2016) and in healthcare is known to enhance service e ciency and client outcomes (Mosadeghrad, 2015;Alharbi et la., 2016;Cacciatore et al, 2019;Grigoroudis et al, 2012).…”