Applying the Balanced Scorecard approach in teaching hospitals: a literature review and conceptual framework

Abstract

Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs.

Deciphering the Imperative: Translating Public Health Quality Improvement into Organizational Performance Management Gains

“…In fact, given the breadth of examples in the peer-reviewed literature, it is evident that Baldrige and BSC have become commonplace tools for improving performance within the health care industry in national and international settings. Specific organizational settings where these QI tools are being employed include hospitals (21,32,51), private dialysis centers (54), academic medical centers (15,57), and, most recently, national health systems (19,30,36,56).…”

Standardized screening for periodontitis as an integral part of multidisciplinary management of adults with type 2 diabetes: an observational cross-sectional study of cohorts in the USA and UK

“…Systematic incorporation of standardized periodontal screening into routine diabetes care is a practical first step toward such integration. Management strategies that employ shared decision-making tools,35 36 such as a balanced health scorecard32 like DXDI, help all stakeholders to visualize the relevant yet disparate domains, gauge progress, and provide periodic feedback, could prove to activate, motivate, and incentivize patients to pursue any needed behavioral and lifestyle changes. Balanced scorecards32 have emerged in multiple sectors, including large healthcare organizations, to more appropriately assess performance in highly specific and complex multidimensional systems.…”

“…Management strategies that employ shared decision-making tools,35 36 such as a balanced health scorecard32 like DXDI, help all stakeholders to visualize the relevant yet disparate domains, gauge progress, and provide periodic feedback, could prove to activate, motivate, and incentivize patients to pursue any needed behavioral and lifestyle changes. Balanced scorecards32 have emerged in multiple sectors, including large healthcare organizations, to more appropriately assess performance in highly specific and complex multidimensional systems. Shared decision-making aids that include condition-specific educational materials have been determined to have beneficial effects on health behavior and health status of patients facing health treatments and screening decisions as well as to promote patient-centeredness among clinicians providing specialty consultations and complex interventions 35 36…”

“…Following the evaluation, patient data were entered into the novel Diabetes Cross-Disciplinary Index (DXDI) (figure 1). DXDI plots the clinical status of 13 diabetes-relevant health domains as a ‘balanced scorecard’ 32. Each domain is stratified into levels 1 (health/absence of disease) through 5 (advanced disease).…”

The barriers to empowering niche-innovations in long-term care

“…The importance of motivation is also highlighted by Trotta et al (2012) who listed it among the key performance areas of hospitals as well as by van den Bosch (2010) who listed "motivation" as one of the key process criteria for successful experimentation.…”