Understanding the context of balanced scorecard implementation: a hospital-based case study in Pakistan
| Autor: | Mats Brommels, Agha Ajmal, Junaid Abdul Razzak, S. M. Wasim Jafri, Fauziah Rabbani, Göran Tomson, Firdous Jahan, Sabrina N. H. Lalji, Max Petzold, Farhat Abbas, Naheed Nabi |
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| Rok vydání: | 2009 |
| Předmět: |
Quality management
Process management viruses Cost-Benefit Analysis Health Informatics Context (language use) Efficiency Organizational Health informatics Health administration Hospitals University Interviews as Topic Organizational Case Studies Nursing Surveys and Questionnaires Health care Medicine Humans Organizational Objectives Pakistan Quality Indicators Health Care Medicine(all) Information Services lcsh:R5-920 Balanced scorecard business.industry urogenital system Health Policy Data Collection Research Health services research Public Health Environmental and Occupational Health General Medicine biochemical phenomena metabolism and nutrition Quality Improvement Models Organizational business lcsh:Medicine (General) |
| Zdroj: | Implementation Science : IS Implementation Science, Vol 6, Iss 1, p 31 (2011) |
| ISSN: | 1748-5908 |
| Popis: | Background As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation. Results Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks. Conclusion Variable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits. |
| Databáze: | OpenAIRE |
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