Engaging physicians and nurses in balanced scorecard evaluation - An implication at Palestinian hospitals and recommendations for policy makers

Abstract

Introduction A balanced scorecard (BSC) is a thorough performance evaluation (PE) instrument. A recent review concluded that hospitals must take into account PE from six perspectives: financial, customer, internal, external, knowledge and growth, and managerial. However, healthcare workers (HCWs) were seldom involved in BSC deployments. This study attempts to involve Palestinian HCWs in BSC implementation to generate health policy recommendations. Methodology In this cross-sectional study, the BSC-HCW1 survey was distributed to engage HCWs in the PE of 14 hospitals between January and October 2021. The differences between physicians’ and nurses’ evaluations were assessed by the Mann‒Whitney U test. The causal relationships between factors were analyzed using multiple linear regression. Multicollinearity of the model was checked. Path analysis was performed to understand the BSC strategic maps based on the Palestinian HCWs’ evaluations. Results Out of 800 surveys, 454 were retrieved. We found low performing factors and KPIs. Specifically, the financial incentives, the sufficiency of time spent with the patients, the HCWs’ education updates on medications and diseases, the hospital equipment quality and maintenance, the inclusion of strengths and weaknesses explanations in HCWs’ appraisals, the HCWs’ intent to stay or leave, and their satisfaction rate. No evaluation differences among physicians and nurses were found. HCWs’ work-life balance and time management (WTLB), quality and development initiatives (QUALDEV), and managerial performance evaluation (MGMTEVAL) have a direct effect on improving HCWs’ loyalty attitudes (LOY). HCW engagement (ENG), MGMTEVAL, and LOY have a direct effect on enhancing the respect toward managers (MTR). QUALDEV, WTLB, LOY, and MGMTEVAL had a direct effect on improving the perceived patient respect toward HCWs. Financial incentives had an indirect effect on improving LOY and PTR. Technology had an indirect effect on QUALDEV improvement. Conclusion BSC-HCW1 successfully engaged HCWs in BSC PE at Palestinian hospitals. This research highlights gaps in the PE of Palestinian hospitals and provides evidence on the importance of improving HCWs’ work-life balance, quality development initiatives, managerial performance, engagement, financial incentives, technology, and loyalty attitudes. Hospital managers should enhance HCWs’ feedback and engagement culture in Palestinian hospitals and link PE with practical action plans and targets.

Why Do We Need an Evidence-Based Book/Encyclopedia to Improve Hospitals’ Performance After COVID-19?

“…Therefore, a recommendation to engage patients and HCWs was recommended. For that reason, two instruments were developed and validated: BSC-PATIENT (8,9) to engage patients in BSC deployments and BSC-HCW1 (10,11) to engage doctors and nurses. Many PE tools highlighted the importance of stakeholders' engagement in the PE of the health system.…”