The study investigates the relationship between strategic alignment, balanced scorecard (BSC) implementation, and optimal performance (OP) in multispecialty hospitals. Data from 530 healthcare professionals in Lucknow, Varanasi, Kanpur, and Prayagraj were collected using a cross-sectional design. Descriptive statistics, correlation analysis, and regression analysis were employed for data analysis. The results demonstrate significant positive relationships between strategic alignment, balanced scorecard, and optimal performance. Both strategic alignment and balanced scorecards were identified as significant predictors of optimal performance, indicating that higher scores in these constructs are associated with higher levels of performance. The findings underscore the critical role of strategic alignment and performance measurement frameworks in enhancing organizational performance in healthcare settings. However, the study faces limitations, including reliance on self-reported data and limited generalizability to other healthcare settings and regions. Future research should explore longitudinal or experimental designs and incorporate objective performance measures to enhance the validity and generalizability of the findings. Overall, the study contributes to understanding strategic management practices in healthcare organizations and highlights avenues for further research in this area.