The deployment of balanced scorecard perspectives and dimensions to improve hospitals’ performance

Abstract

This dissertation constitutes four core studies and four implementations. Two systematic reviews of the balanced scorecard’s (BSC) impact and dimensions were performed. To develop the BSC-PATIENT and BSC-HCW1, the Delphi technique was utilized to generate the items and to assess the content validity, followed by translation and pretesting at one hospital. Then, a convenience sample of 1000 patients and 800 healthcare workers (HCWs) was recruited at 14 hospitals with the maximum variation technique between January and October 2021. Construct validity was tested through exploratory factor analysis, confirmatory factor analysis, composite reliability, interitem correlation, and corrected item total correlation. The developed tools were used to engage patients, doctors, and nurses in evaluating Palestinian hospitals by assessing their experiences and attitudes. The differences in evaluations based on patient admission status and HCWs’ profession were analyzed using the Mann‒Whitney U test. Causal relationships were analyzed using multiple linear regression and path analysis to draw BSC strategic maps. For the statistical analysis of the cross-sectional studies, IBM SPSS, IBM Amos, and R software programs were utilized. As a result, a positive impact was found in 20 studies. The thematic analysis of the extracted 797 key performance indicators (KPIs) resulted in 45 subdimensions and 13 major dimensions. The best model of BSC-PATIENT and BSC-HCW1 comprised ten constructs with 36 items and nine factors with 28 items, respectively. The instruments’ psychometric characteristics showed adequacy. The implementation of BSC-PATIENT at Palestinian hospitals provides strong evidence for the impact of patients’ information experience on their attitudes. Palestinian health policy makers must prioritize the design and delivery of patient education programs into their action plans and encourage two-way information communication with patients. The implementation of BSC-HCW1 recommends improving low-performing indicators, such as the time spent with patients, HCWs’ knowledge of medications and diseases, the quality of hospital equipment and maintenance, and the inclusion of strengths and weaknesses in HCWs’ evaluations to enhance HCWs’ loyalty and reduce their attempts to leave. For Palestinian hospital managers to be respected more, they must include HCWs in their action plans and explain their evaluation criteria. Patients will respect Palestinian HCWs more if they prioritize their education and work quality, spend more time with patients, and reflect more loyalty. The results can be generalized in Palestine since it encompassed 30% of Palestinian hospitals from all categories.