Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Balanced performance measurement in research hospitals: the participative case study of a haematology department

Authors: Simona Catuogno, Claudia Arena, Sara Saggese, Fabrizia Sarto

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

The paper aims to review, design and implement a multidimensional performance measurement system for a public research hospital in order to address the complexity of its multifaceted stakeholder requirements and its double institutional aim of care and research.

Method

The methodology relies on a participative case study performed by external researchers in close collaboration with the staff of an Italian research hospital.

Results

The paper develops and applies a customized version of balanced scorecard based on a new set of performance measures. Our findings suggest that it can be considered an effective framework for measuring the research hospital performance, thanks to a combination of generalizable and context-specific factors.

Conclusions

By showing how the balanced scorecard framework can be customized to research hospitals, the paper is especially of interest for complex healthcare organizations that are implementing management accounting practices. The paper contributes to the body of literature on the application of the balanced scorecard in healthcare through an examination of the challenges in designing and implementing this multidimensional performance tool. This is one of the first papers that show how the balanced scorecard model can be adapted to fit the specific requirements of public research hospitals.
Literature
1.
Mintzberg H. Structure in fives – designing effective organizations. Prentice-Hall, Englewood Cliffs: NJ; 1993.
2.
Funck E. The balanced scorecard equates interests in healthcare organizations. J Acc Org Change. 2007;3(2):88–103.CrossRef
3.
Baker G, Pink G. A balanced scorecard for Canadian hospitals. Healthc Manage Forum. 1996;8(4):7–13.CrossRef
4.
Lenert L. Transforming healthcare through patient empowerment. St Healt T. 2010;153:159–75.
5.
Kleinpell RM. Whose outcomes: patients, providers, or payers? Nurs Clin N Am. 1997;32(3):513–20.
6.
Dansky KH, Gamm LS. Accountability framework for managing stakeholders of health programs. J Health Organ Manag. 2004;18(4):290–304.CrossRefPubMed
7.
Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998;279(20):1638–42.CrossRefPubMed
8.
De Vos M, Graafmans W, Kooistra M, Meijboom B, Van Der Voort P, Westert G. Using quality indicators to improve hospital care: a review of the literature. Int J for Qual Health C. 2009;21(2):119–29.CrossRef
9.
Voelker K, Rakich J, French G. The balanced scorecard in healthcare organizations: a performance measurement and strategic planning method. Hosp Top. 2001;79(3):13–24.CrossRefPubMed
10.
Lega F, Vendramini E. Budgeting and performance management in the Italian national health system (INHS): assessment and constructive criticism. J Health Organ Manag. 2008;22(1):11–22.CrossRefPubMed
11.
Emmanuel C, Otley D, Merchant K. Accounting for management control. Springer: US; 1990.CrossRef
12.
Ballantine J, Brignall S, Modell S. Performance measurement and management in public health services: a comparison of UK and Swedish practice. Manage Account Res. 1998;9(1):71–94.CrossRef
13.
Nadzam DM, Nelson M. The benefits of continuous performance measurement. Nurs Clin North Am. 1997;32(3):543–59.PubMed
14.
McIntyre D, Rogers L, Heier EJ. Overview, history, and objectives of performance measurement. Health Care Financ R. 2001;22(3):7–43.
15.
Kaplan RS, Norton DP. Transforming the balanced scorecard from performance measurement to strategic management: part I. Account Horiz. 2001;15(1):87–104.CrossRef
16.
Purbey S, Mukherjee K, Bhar C. Performance measurement system for healthcare processes. Int J Prod Perf Manag. 2007;56(3):241–51.CrossRef
17.
Northcott D, Ma'amora TT. Using the balanced scorecard to manage performance in public sector organizations: issues and challenges. Int J Public Sect Manag. 2012;25(3):166–91.CrossRef
18.
Kaplan RS, Norton DP. Putting the balanced scorecard to work. Perform Meas Manage Appraisal Sourcebook. 1995;66:17511.
19.
Chow C, Ganulin D, Haddad K, Williamson J. The balanced scorecard: a potential tool for energizing and focusing healthcare organization management. J Health Manag. 1998;43(3):263–80.
20.
Modell S. Performance measurement myths in the public sector: a research note. Finan Account Manag. 2004;20(1):39–55.CrossRef
21.
22.
Gurd B, Gao T. Lives in the balance: an analysis of the balanced scorecard (BSC) in healthcare organizations. Int J of Prod Perf Manage. 2007;57(1):6–21.CrossRef
23.
Zelman WN, Blazer D, Gower JM, Bumgarner PO, Cancilla LM. Issues for academic health centers to consider before implementing a balanced-scorecard effort. Acad Med. 1999;74(12):1269–77.CrossRefPubMed
24.
Castañeda Méndez K, Mangan K, Lavery A. The role and application of the balanced scorecard in healthcare quality management. J Healthc Qual. 1998;20(1):10–3.CrossRefPubMed
25.
Santiago JM. Use of the balanced scorecard to improve the quality of behavioral health care. Psychiatr Serv. 1999;50(12):1571–6.CrossRefPubMed
26.
Potthof SO, Ison D, Thompson N, Kissner M. Long-term care management: a balanced performance measurement system. J Strat Perf Measurement. 1999;31:16–22.
27.
Pineno CJ. The balanced scorecard: an incremental approach model to health care management. J Health Care Finance. 2002;28(4):69–80.PubMed
28.
Kumar A, Ozdamar L, Peng NC. Procurement performance measurement system in the health care industry. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2005;18(2):152–66.CrossRefPubMed
29.
Schmidt S, Bateman I, Breinlinger-O’Reilly J, Smith P. A management approach that drives actions strategically: balanced scorecard in a mental health trust. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(2–3):119–35.CrossRefPubMed
30.
Rimar S, Garstka SJ. The BSC: development and implementation in an academic clinical department. Acad Med. 1999;74(2):114–22.CrossRefPubMed
31.
Meliones JN, Ballard R, Liekweg R, Burton W. No mission—no margin: it’s that simple. J Health Care Finance. 2001;27(3):21–9.PubMed
32.
Weiss A, Downar J. Ontario hospitals are not using palliative care performance indicators in their balanced scorecards. J Pain Symptom Manag. 2013;46(2):1–5.CrossRef
33.
Josey C, Kim I. W. Implementation of the balanced scorecard at Barberton citizens hospital. J Corp Account Financ. 2008;19(3):57–63.CrossRef
34.
Nudurupati SS, Bititci US, Kumar V, Chan FT. State of the art literature review on performance measurement. Comput Ind Eng. 2011;60(2):279–90.CrossRef
35.
Morgan D, Morgan R. Single-case research methods for the Behavioral and health sciences. 1st ed. Thousand Oaks: CA:Sage; 2009.CrossRef
36.
Baskerville R. Distinguishing action research from participative case studies. J Syst Inform Tech. 1997;1(1):25–45.
37.
Anessi Pessina E, Cantù E. Whither managerialism in the Italian national health service? Int J Health Plan M. 2006;21(4):327–55.CrossRef
38.
Carbone C, Lega F, Salvatore D, Tozzi V. Ospedali e università: illusioni, delusioni e realtà di un rapporto difficile, in Anessi Pessina E. and Cantù E. (Eds.). L’aziendalizzazione della sanità in Italia Rapporto OASI 2007. Milano: Egea; 2009.
39.
Yin RK. Case study research: design and methods. 3rd ed. Thousand Oaks: Sage; 2006.
40.
Ahrens T, Chapman CS. Accounting for flexibility and efficiency: a field study of management control systems in a restaurant chain. Contemp Account Res. 2004;21:271–301.CrossRef
41.
Pettigrew A. Longitudinal field research on change: theory and practice. Organ Sci. 1990;1(3):267–92.CrossRef
42.
43.
Elliot J. Action research for educational change. UK: McGraw-Hill Education; 1991.
44.
Eisenhardt KM. Building theories from case study research. Acad Manag Rev. 1989;14:532–50.
45.
Hewison A. Qualitative management research in the NHS: a classic case of counting to one? J Health Organ Manag. 2003;17(2):122–37.CrossRefPubMed
46.
Lohman C, Fortuin L, Wouters M. Designing a performance measurement system: a case study. Eur J Oper Res. 2009;156(2):267–86.CrossRef
47.
Wouters M, Sportel M. The role of existing measures in developing and implementing performance measurement systems. Int J Oper Prod Man. 2005;25(11):1062–82.CrossRef
48.
Schmidberger S, Balsb L, Hartmanna E, Jahns C. Ground handling services at European hub airports: development of a performance measurement system for benchmarking. Int J Prod Econ. 2009;117(1):104–16.CrossRef
49.
Neely AD, Adams C, Kennerley M. The performance prism: the scorecard for measuring and managing business success. London: Prentice Hall Financial Times; 2002.
50.
Neely A, Gregory M, Platts K. Performance measurement system design: a literature review and research agenda. Int J Oper Prod Manag. 2005;25(12):1228–63.CrossRef
51.
Kennerley M, Neely A. Measuring performance in a changing business environment. Int J Oper Prod Manag. 2003;23(2):213–29.CrossRef
52.
Campbell J, Quincy C, Osserman J, Pedersen OK. Coding in-depth semi-structured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294–320.CrossRef
53.
Zelman WN, Pink GH, Matthias CB. Use of the balanced scorecard in health care. J Health Care Finance. 2003;29(4):1–16.PubMed
54.
Weir E, D'Entremont N, Stalker S, Kurji K, Robinson V. Applying the balanced scorecard to local public health performance measurement: deliberations and decisions. BMC Public Health. 2009;9(1):127.CrossRefPubMedPubMedCentral
55.
Greenberg A, Angus H, Sullivan T, Brown AD. Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada. Int J Qual Health Care. 2005;17(2):107–14.CrossRefPubMed
56.
Parkinson J, Tsasis P, Porporato M. A critical review of financial measures as reported in the Ontario hospital balanced scorecard. J Health Care Finance. 2006;34(2):48–56.
57.
Lilian Chan YC. How strategy map works for Ontario's health system. Int J Public Sect Manage. 2009;22(4):349–63.CrossRef
58.
Pink GH, McKillop I, Schraa EG, Preyra C, Montgomery C, Baker GR. Creating a balanced scorecard for a hospital system. J Health Care Finance. 2001;27(3):1–20.PubMed
59.
Deryl Northcott TMT. Using the balanced scorecard to manage performance in public sector organizations: issues and challenges. Int J Public Sect Manage. 2012;25(3):166–91.CrossRef
60.
61.
Jennings BM, Staggers N, Brosch LR. A classification scheme for outcome indicators. J Nurs Scholarship. 1999;31(4):381–8.CrossRef
62.
Compagni A, Tediosi F. Implementing performance-based funding for health research: when governance and procedural fairness matter. Public Admin. 2012;90(2):313–34.CrossRef
63.
France G, Taroni F, Donatini A. The Italian health-care system. Health Econ. 2005;14:187–202.CrossRef
64.
Passerino C, Zotta G. L’evoluzione storico-normativa degli Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) nel panorama della sanità italiana. G Ital Med Lav Ergon. 2008;30(2):192–208.PubMed
65.
Sarto F, Veronesi G, Kirkpatrick I, Cuccurullo C. Exploring regionalism of public management reform: the case of the Italian hospital sector. Policy Polit. 2016;44(4):525–45.CrossRef
66.
Carbone C, Lega F, Prenestini A. La governance delle Aziende Ospedaliero-Universitarie: perché non funziona, come potrebbe migliorare, in Cantù E. (Ed.). L’aziendalizzazione della sanità in Italia Rapporto OASI 2010. Milano: Egea; 2010.
67.
Bisbe J, Barrubés J. The balanced scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations. Revista Española de Cardiología (English Edition). 2012;65(10):919–27.CrossRef
68.
Niven PR. Balanced scorecard diagnostics: maintaining maximum performance. Hoboken, NJ: John Wiley & Sons; 2005.
69.
Trotta A, Cardamone E, Cavallaro G, Mauro M. Applying the balanced scorecard approach in teaching hospitals: a literature review and conceptual framework. Int J Health Plann Manage. 2013;28(2):181–201.CrossRefPubMed
70.
Inamdar N, Kaplan RS, Bower M. Applying the balanced scorecard in healthcare provider organizations. J Healthc Manage. 2001;47(3):179–95.
71.
Nutley S, Smith PC. League tables for performance improvement in health care. J Health Serv Res Policy. 1998;3(1):50–7.CrossRefPubMed
72.
Lemieux-Charles L, McGuire WL. What do we know about health care team effectiveness? A review of the literature. Med Care Res Rev. 2006;63(3):263–300.CrossRefPubMed
73.
Klazinga N, Stronks K, Delnoij D, Verhoeff A. Indicators without a cause. Reflections on the development and use of indicators in health care from a public health perspective. Int J Qual Heal Care. 2001;13(6):433–8.CrossRef
74.
Globerson S. Issues in developing a performance criteria system for an organization. Int J Prod Res. 1985;23(4):639–46.CrossRef
75.
Nuti S, Seghieri C, Vainieri M. Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience. J Manag Gov. 2013;17(1):59–69.CrossRef
76.
Cheng SM, Thompson LJ. Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned. J Health Organ Manag. 2006;20(4):335–43.CrossRefPubMed
77.
78.
Young J, Bell R, Khalfan A, Lindquist E. Evaluating the balanced scorecard at the university health network: an impact assessment. Healthc Q. 2008;11(2):52–6.CrossRefPubMed
79.
Metadata
Title
Balanced performance measurement in research hospitals: the participative case study of a haematology department
Authors
Simona Catuogno
Claudia Arena
Sara Saggese
Fabrizia Sarto
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2479-6

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

Evaluation of a practical expert defined approach to patient population segmentation: a case study in Singapore

Research article

Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi

Research article

The effect of facility-based antiretroviral therapy programs on outpatient services in Kenya and Uganda

Research article

Adaption, implementation and evaluation of collaborative service improvements in the testing and result communication process in primary care from patient and staff perspectives: a qualitative study

Research article

The quality, safety and governance of telephone triage and advice services – an overview of evidence from systematic reviews

Research article

A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand