The dynamic use of a balanced scorecard in an Italian public hospital

Abstract

Purpose: This paper aims to analyse the dynamic use of the balanced scorecard (BSC) in an Italian public hospital.Design/Methodology/Approach: A longitudinal case study was conducted at an Italian public teaching hospital over a period of 5 years. The emergence of dynamic use of BSC was traced over a different combination of social, political, economic and organizational realities. A deeper understanding of these realities requires the adoption of a holistic approach to BSC use. Henri's types of system use (i.e., monitoring, attention focussing, strategic decision-making and legitimizing) frame this approach in a more concrete manner.Findings: This study adds to the debate on whether BSC is used for aspects other than monitoring in public contexts.The case study offers the first example of a legitimizing use of the system and a first longitudinal case study that traces a dynamic use of BSC: the use evolves from monitoring and attention focussing to monitoring and legitimization. Norms, political parties and top managers play a determining role in this process.

The Evolution of Balanced Scorecard in Healthcare: A Systematic Review of Its Design, Implementation, Use, and Review

“…Oliveira et al [ 65 ] adopted a longitudinal case study in order to understand how BSC is implemented in healthcare settings and whether BSC includes neo bureaucratic traits. In the same way, other authors adopted longitudinal case studies for understanding the evolution of BSC over a fixed timeframe in the same hospital [ 42 ]. Case studies have been adopted to investigate the BSC design [ 45 , 66 , 67 ].…”

“…Figure 2 reveals the framework adopted to analyze papers. As BSC literature outlines, there are four phases in the BSC adoption [ 40 , 58 ]: Regarding the BSC design, the analysis aims at emphasizing the adopted perspectives and the main key performance indicators used; Regarding the BSC implementation, the focus is on the drivers and barriers that push or hinder the implementation of BSC; Regarding BSC use, the research team adopted a highly cited work that distinguished BSC use in monitoring, strategic decision making, attention focusing, and legitimization, also recently adopted in an empirical study focused on BSC in a hospital [ 42 ]; Regarding the BSC review, in line with [ 40 ], the review process includes a set of mechanisms for reviewing targets and standards and processes for a periodical review of the set of measures adopted. …”

“…Regarding BSC use, the research team adopted a highly cited work that distinguished BSC use in monitoring, strategic decision making, attention focusing, and legitimization, also recently adopted in an empirical study focused on BSC in a hospital [ 42 ];…”

“…Moreover, in an uncertain and continuously evolving environment, the design of the adopted BSC needs to be updated to cope with the external changes and the target and performance indicators need to be reviewed to be aligned with the organization’s strategy. The traditional BSC perspectives [ 32 ] are not always able to catch the new needs, such as the environmental dimension [ 41 ], or integrated care and humanization [ 42 ]. As a consequence, specific redesign of BSC perspectives aligned with the organization’s strategy and planned updating processes for measures and targets should be carried out by the organizations.…”

“…Regarding the use of BSC among healthcare institutions, only a few research explicitly emphasizes how organizations use BSC [ 42 , 48 ] according to the adopted classification of BSC usage [ 49 ]. Related to the public sector, an empirical study highlighted that organizations have to assess several mandatory targets, they used BSC for legitimacy seeking [ 48 ].…”