Patient engagement in balanced scorecard and the influence of patient experiences on their attitudes- An implication at Palestinian hospitals

Abstract

Introduction The balanced scorecard (BSC) was implemented to improve hospitals’ performance evaluations (PE) in the last 30 years. BSC consists of six perspectives: financial, customer, internal, external, knowledge and growth, and managerial. However, patients were seldom engaged in such implementations. This research aims to engage Palestinian patients in BSC implementations. Methodology This is a cross-sectional study. We collected data between January and October 2021 using the printed BSC-PATIENT survey. We evaluated the patients’ experiences and attitudes toward BSC dimensions (BSCP ATT). The differences in evaluations based on admission status were also analyzed using the Mann‒Whitney U test. Additionally, we analyzed the causal relationships between patients’ experiences and attitudes using multiple linear regression, and the multicollinearity of the model was tested. Finally, the path analysis was performed to understand the BSC strategic maps based on the Palestinians’ evaluations. Results The mean scores for Palestinian patient experiences evaluation showed that the services experience factor had the highest score (87.7 ± 17.7), and the patient care experience factor had the lowest score (57 ± 34.5). The patient experiences collectively predicted 56.4% of the variance in the BSCP ATT. The experiences factors of information (β = 0.400, t = 13.543, P < 0.001), patient care (β = 0.241, t = 8.061, P < 0.001), services (β = 0.176, t = 6.497, P < 0.001), and building (β = 0.177, t = 6.308, P < 0.001) had the highest impact on BSCP ATT. The price had only a weak negative influence (β=-0.051, t=-2.040, P = 0.042). Accessibility to hospitals did not have any impact on BSCP ATT. Significant differences between inpatient and outpatients’ evaluations in regard to experiences related to patient care (P = 0.042), services (P < 0.001), accessibility (P < 0.001), and BSCP ATT (P = 0.003) were found. Conclusion Managers of Palestinian hospitals should prioritize enhancing the patient experience, particularly the information experience. The importance of patient education programs and information sharing with patients cannot be overstated. Other experiences as patient care, services, and building are also significant. By focusing on separate evaluations of patients' experiences and attitudes, the BSC strategic maps will be easier to understand from the patients' point of view. BSC-PATIENT survey may assist hospitals managers in achieving this objective and enhancing their action plans. Palestinian hospitals must enhance patients’ feedback and engagement culture.

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

“…In our BSC systematic review (18), we found that there is a need to add the managerial perspective in addition to the external perspective to the BSC design, which means having to balance the focus on six perspectives. Additionally, we concluded that there is a need to have a separate consideration when evaluating knowledge and technology subdimensions when considering the knowledge and growth perspective (19)(20)(21).…”

“…This cross-sectional design is a subset of a broad multisite project (15,(18)(19)(20)(21). The project's overall aim is to use BSC perspectives and dimensions to include a wide range of stakeholders in the strategic improvement of Palestinian hospitals' performance.…”