Reviewing the Application of the Balanced Scorecard with Implications for Low-Income Health Settings

Abstract

High-income countries (HICs) are increasingly making use of the balanced scorecard (BSC) in healthcare. Evidence about BSC usage in low-income countries (LICs) is deficient. This study assessed feasibility of BSC use in LICs. Systematic review of electronic databases shows that the BSC improved patient, staff, clinical, and financial outcomes in HICs. To translate the experience of BSC use in HICs to their use in LICs, the applicability parameters of the National Committee for Quality Assurance were applied. Despite contextual challenges, pilot testing of BSC use can be undertaken in selected LICs. Committed leadership, cultural readiness, quality information systems, viable strategic plans, and optimum resources are required.

Designing a balanced scorecard for a tertiary care hospital in Pakistan: a modified Delphi group exercise

“…Designing the BSC was possible in our study because most of the necessary prerequisites for successful BSC implementation in LICs (committed leadership, viable strategic plans and information systems etc.) were already in place and cultural readiness for BSC usage had previously been assessed (Rabbani et al, 2007;Rabbani et al, 2008). The modified Delphi method successfully incorporated views from health personnel and specialists in the development of a BSC.…”

“…In the context of low income countries (LICs), however, we know little about successful models to promote greater management effectiveness at the hospital level (Hartwig et al, 2008). Evidence about BSC usage in LICs is deficient mainly due to lack of committed leadership, cultural readiness, quality information systems, viable strategic plans, and optimum resources (Rabbani et al, 2007). Simple dissemination of written guidelines in LICs is proving to be often ineffective (Rowe et al, 2005) and health managers face significant challenges in developing and managing appropriate systems (Green and Collins, 2003).…”

Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: Policy coherence and application lessons for low and middle income countries

“…Only one health system (macro level) application of the BSC has been documented from Afghanistan [9,10] and one hospital (micro level) application of the BSC was reported from Pakistan [11]. The implementation of the BSC in LMICs was strongly supported in the literature as an answer to the limited resources and the deficiency in clear guidelines and protocols [7]. While its development and implementation cannot be replicated from HICs, careful adaptation of the BSC approach is needed in order to address the needs and local context of LMICs.…”

“…While its development and implementation cannot be replicated from HICs, careful adaptation of the BSC approach is needed in order to address the needs and local context of LMICs. The literature recommends implementing the BSC gradually starting with assessment of readiness, piloting at a small number of organizations and expansion, followed by evaluation [7]. The health care system in Lebanon, a LMIC from the EMR, lacks a national set of indicators for hospital performance benchmarking and improvement.…”

Use of Balanced Scorecard Methodology for Performance Measurement of the Health Extension Program in Ethiopia

“…Despite its strategic benefit and wide application in developed countries, the application of scorecard in developing countries has been limited, perhaps due to the unfavorable health-care environment. 14,[16][17][18][19][20][21] Among the few developing countries, Afghanistan has been the pioneer in integrating BSC into its national health system. 14,16,18 In 2010, FMOH introduced BSC as a planning and management tool and developed its Health Sector Development Program (HSDP IV) based on the BSC framework.…”