TY - JOUR
T1 - Understanding the context of balanced scorecard implementation
T2 - A hospital-based case study in Pakistan
AU - Rabbani, Fauziah
AU - Lalji, Sabrina N.H.
AU - Abbas, Farhat
AU - Jafri, S. M.Wasim
AU - Razzak, Junaid A.
AU - Nabi, Naheed
AU - Jahan, Firdous
AU - Ajmal, Agha
AU - Petzold, Max
AU - Brommels, Mats
AU - Tomson, Goran
N1 - Funding Information:
We would like to thank the senior Aga Khan University (AKU) leadership – both the former and current Vice President of Health Services Dallas Ariotti and Allaudin Merali respectively, for encouraging us to proceed with the work related to BSC. We are grateful to Shafaq Ambreen for her secretarial assistance and to all the faculty and staff of the hospital who contributed as study participants or were part of the BSC implementation team. We thank Bo Badr Saleem Lindblad, professor emeritus of international child health, Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet Medical University, Stockholm, Sweden, and visiting professor, AKU, Karachi, Pakistan, for his overall support; Thomas Mellin at IHCAR, Department of Public Health Services, Karolinska Institutet, for connecting us to various information technology resources. We wish to acknowledge our grant sources: Swedish Institute (SI), Swedish South Asian Network (SASNET), WHO EMRO, AKU Faculty Development Award and AKU University Research Council (URC). Without their support this study would not have been possible.
PY - 2011/3/31
Y1 - 2011/3/31
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=79953165399&partnerID=8YFLogxK
U2 - 10.1186/1748-5908-6-31
DO - 10.1186/1748-5908-6-31
M3 - Article
C2 - 21453449
AN - SCOPUS:79953165399
SN - 1748-5908
VL - 6
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 31
ER -