Development of performance indicators by the Delphi study for foodservice operations in senior welfare centers: application of the balanced scorecard.

With the rapid growth of the elderly population, the number of elderly welfare centers has expanded significantly. However, the current regulations and standards for foodservice management in these centers are inadequate. To address this issue, this study aimed to develop objective and integrated performance indicators based on the Balanced Scorecard for foodservice programs in elderly welfare centers. To evaluate the validity and reliability of the performance indicators, two Delphi studies were conducted in April 2017. The Delphi survey included the evaluation of strategic goals, financial perspective, customer perspective, learning and growth perspective, and the internal process perspective. The degree of consensus among experts was assessed using Kendall's W-test. As a result of the study, the study ultimately identified 33 performance indicators from 12 strategic goals in four perspectives, which could be used as an efficient tool to evaluate, supplement, and improve foodservice in elderly welfare centers. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01468-x.

Keep-or-drop multidimensional control systems in professional organisations: evidence on the use of the balanced scorecard in healthcare.

PURPOSE: During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs. DESIGN/METHODOLOGY/APPROACH: We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC. FINDINGS: We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals' commitment; (2) information technology and the controller's technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance. ORIGINALITY/VALUE: The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

Assessing midwifery services in Iran via the balanced scorecard framework.

This study investigates the impact of intra-organizational information, midwife job satisfaction and performance assessment on the quality of midwife services. The questions are empirically tested with survey data obtained from 276 midwives, specialist doctors and nurses, and mothers who recently gave birth in a cross-section of Iranian public healthcare organizations. The results from a structural equation model suggest that an improved performance assessment system leads to higher quality midwife services. In addition, the results indicate that midwife job satisfaction and intra-organizational information increases the quality of midwife services, both directly and indirectly, through the mediating effect of a performance assessment system. Our study contributes to the growing research exploring the interface between accounting and health issues by recognizing the importance of a performance assessment system of midwifery services via the balanced scorecard framework for understanding the quality of midwife services.

Implementing an intervention to improve leadership/management of public healthcare services in the Free State Province, South Africa: lessons learned.

Background: Based on the World Health Organization's health systems strengthening framework, the Health Systems Governance and Accountability (HSGA) intervention to strengthen public health leadership/management, service integration and outcomes was developed in the Free State. Objectives: This study describes the process to implement and measure the effects of the HSGA intervention for system-wide improvement of leadership/management under routine conditions in a resource-constrained setting. Methods: Based on normalisation process theory, participatory discussions were held with health managers, staff and local stakeholders to attain buy-in. Evaluation of the implementation process considered progress in improving leadership/management through application of the Balanced Scorecard (BSC). All provincial reporting units were assessed during 2014/15 and again during 2015/16. Results: The mean scores on three BSC perspectives improved statistically significantly from 2014/15 to 2015/16: customer (p=0.0085), internal business processes (p=0.0008) and finance (p=0.0001). Overall leadership/management also improved significantly (p=0.0007). Conclusion: Improvement in leadership/management resulting from implementation of the HSGA intervention was observed during the two years under study. From this experience, successful implementation of a health systems strengthening intervention hinges on a participatory design, appropriate use of theory, as well as application of an evaluation approach to assess the success of implementation.

Resolving the practical factors in the healthcare system management by considering a combine approach of AHP and ANP methods.

Healthcare System Management (HSM) is a technique for integrating technology in public hospitals. Knowledge of strategies and decision-making issues is crucial for improving hospital services during the HSM implementation since it directly impacts the efficiency of the hospital and the level of the patient healthcare system. To address the research gap, this study presents a hybrid decision making model that combines the Analysis Hierarchical Process (AHP) method and the Analytic Network Process (ANP) to select Balanced Scorecard Policy (BSP) indicators for evaluating HSM application in a resource-limited background. The hybrid modeling approach not only assists in allocating resources for the execution of HSM but also in determining the significance of the relationship between each analyzed aspect. The hierarchical structure used in this study's quantitative and qualitative relations assessment can also assist various medical facilities in determining how the evaluation criteria and the resources needed to provide HSM services are related. In addition, the management decision policy is shown by the BSP in a healthcare center by combining the two methods mentioned satisfy the goal of strategy weights and limited resources. Finally, the article results indicate that the proposed method increases the efficiency of decisions and maximizes the can improve the reliability in HSM.

Evaluating the adoption of cybersecurity and its influence on organizational performance.

Cyberattacks negatively impact the performance of enterprises all around the globe. While organizations invest more in cybersecurity to avoid cyberattacks, studies on the factors affecting their overall cybersecurity adoption and awareness are sparse. In this paper, by integrating the diffusion of innovation theory (DOI), technology acceptance model (TAM), and technology-organization-environment (TOE) with the balanced scorecard approach, we propose a comprehensive set of factors that influence cybersecurity adoption and assess the effects of these factors on organizational performance. Data are collected through a survey of IT experts in small and medium-sized enterprises (SMEs) in the United Kingdom, with 147 valid responses. Structural equation modeling based on a statistical package for the social sciences (SPSS) was used to assess the model. The findings identify and confirm the importance of eight factors affecting SMEs' cybersecurity adoption. Moreover, cybersecurity technology adoption is found to positively impacts organizational performance. The proposed framework depicts variables influencing cybersecurity technology adoption and assesses their importance. The outcomes of this study provide a basis for future research and can be adopted by IT and cybersecurity managers to identify the most appropriate cybersecurity technologies that positively impact their company's performance.

Engaging physicians and nurses in balanced scorecard evaluation-An implication at Palestinian hospitals and recommendations for policy makers.

Introduction: Healthcare workers (HCWs) are seldom involved in balanced scorecard (BSC) deployments. This study aims to incorporate Palestinian HCWs in the BSC to create health policy recommendations and action plans using BSC-HCW1, a survey designed and validated based on BSC dimensions. Methodology: In this cross-sectional study, the BSC-HCW1 survey was delivered to HCWs in 14 hospitals from January to October 2021 to get them involved in PE. The differences between physicians' and nurses' evaluations were assessed by the Mann-Whitney U-test. The causal relationships between factors were analyzed using multiple linear regression. The multicollinearity of the model was checked. Path analysis was performed to understand the BSC strategic maps based on the Palestinian HCWs' evaluations. Results: Out of 800 surveys, 454 (57%) were retrieved. No evaluation differences between physicians and nurses were found. The BSC-HCW1 model explains 22-35% of HCW loyalty attitudes, managerial trust, and perceived patient trust and respect. HCWs' workload time-life balance, quality and development initiatives, and managerial performance evaluation have a direct effect on improving HCWs' loyalty attitudes (ß = 0.272, P < 0.001; ß = 0.231, P < 0.001; ß = 0.199, P < 0.001, respectively). HCWs' engagement, managerial performance evaluation, and loyalty attitudes have a direct effect on enhancing HCWs' respect toward managers (ß = 0.260, P < 0.001; ß = 0.191, P = 0.001; ß = 0.135, P = 0.010, respectively). Quality and development initiatives, HCWs' loyalty attitudes, and workload time-life balance had a direct effect on improving perceived patient respect toward HCWs (ß = 254, P < 0.001; ß = 0.137, P = 0.006, ß = 0.137, P = 0.006, respectively). Conclusion: This research shows that it is important to improve low-performing indicators, such as the duration of time HCWs spend with patients, their knowledge of medications and diseases, the quality of hospital equipment and maintenance, and the inclusion of strengths and weaknesses in HCWs' evaluations, so that HCWs are more loyal and less likely to want 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 since it encompassed 30% of Palestinian hospitals from all categories.

Measuring circularity of a manufacturing organization by using sustainable balanced scorecard.

In recent years, circular economy has become a matter of great importance because of its ability to contribute toward economic, environmental, and social aspects of the sustainability. The circular economy approaches help in resource conservation by reducing, reusing, and recycling products/parts/components/materials. On the other hand, Industry 4.0 is coupled with emerging technologies, which support the firms in efficient resource utilization. These innovative technologies can transform the present manufacturing organizations by reducing resource extraction, CO2 emissions, environmental damage, and power consumption and improve it into a more sustainable manufacturing organization. Industry 4.0 along with circular economy concepts greatly improves the circularity performance. However, there is no framework found for measuring the circularity performance of the firm. Therefore, the current study aims to develop a framework for measuring performance in terms of circularity percentage. In this work, graph theory and matrix approach are employed for measuring the performance based on a sustainable balanced scorecard such as internal process, learning and growth, customer and financial with environmental and social perspectives. A case of an Indian barrel manufacturing organization is discussed for the illustration of proposed methodology. Based on "circularity index" of the organization and the maximum possible circularity index, the circularity was found to be 5.10%. It indicates that there is a huge potential for the improvement in the circularity of the organization. An in-depth sensitivity analysis and comparison are also performed to validate the findings. There are very few studies on measuring the circularity. The study developed the approach for measuring circularity, which may be utilized by industrialists and practitioners for improving the circularity.

A comprehensive bibliometric study of the balanced scorecard.

This research provides a deeper knowledge in the Balanced Scorecard (BSC) insight by using the bibliometric technique. The existing gap between the traditional literatura reviews and previous bibliometric studies, is covered as it is the first comprehensive analysis carried out in applying quantity, quality, and structural indicators. Web of Science Core Collection was used as the source of information, considering it the most accurate and suitable data base for these studies. This research covers the wider period-of-time possible, from 1992 to 2020, with a final sample of 771 articles in 466 reviews. Quantity indicators show the high interest that the BSC still has in the scholar's community, pointing out Kaplan and Norton as the most productive authors,and confirming that 'management', 'business' and 'accountability' are its most common field of activity, although others as 'systems' and sustainability' are coming to prominence; 'Balanced Scorecard' appears as the most remarkable keyword. Quality indicators found 32,706 citations, with Kaplan and Norton occupying again top positions as well as 'Harvard Business Review' as the most impacting review both in cited articles and in average. Co-citation analysis reveals the existence of a triple corecluster for articles, based on the theory, literature reviews, and case-studies.

Applying the Balanced Scorecard to Build Service Performance Measurements of Medical Institutions: An AHP-DEMATEL Approach.

The main purpose of this study is to explore the application of the balanced scorecard (BSC) to service performance measurements of medical institutions using the analytic hierarchy process (AHP) and decision making and trial evaluation laboratory (DEMATEL). According to the concept of BSC, a total of four evaluation dimensions and twenty-two indicators of medical service performance measurements were developed. To collect data, this study delivered expert questionnaires to medical-related professional supervisors, deans, and heads of medical institutions in Taiwan. By combining the AHP and DEMATEL, the priority and causality of service performance standards in medical institutions were obtained. The results of this study show that the customer dimension is the most important service performance measurement dimension for medical institutions. The seven key service performance measurement indicators that are most important for medical institutions, in order, are "complete and comfortable equipment", "competitiveness of the medical profession", "continuity of patient-to-hospital treatment", "classification of medical profession according to customers (VIP system)", "complete medical service", "complete salary, remuneration, and policy", and "medical incomes of institutions". In terms of causality, provided the complete services of medical institutions are improved, the continuity of patient-to-hospital treatment, the competitiveness of the medical profession, and the medical incomes of institutions would be influenced.

The Use of Balanced Scorecards in Mental Health Services: an Integrative Review and Thematic Analysis.

Performance management of mental health services (MHS) through quality reporting of strategic indicators and goals is essential to improve efficiency and quality of care. One such method is the balanced scorecard (BSC). This integrative review of peer-reviewed and industry implemented BSCs in MHS aims to inform future development of a more comprehensive mental health-focused benchmarking tool. A two-part systematic literature search consisted of peer-reviewed published literature on MHS specific BSCs utilising the PRISMA guidelines in addition to industry published BSCs available online. A total of 17 unique BSCs were identified. A total of 434 indicators were subject to thematic analysis identifying 11 key themes: prevalence, accessibility, services provided, clinical outcomes, client satisfaction, client involvement, staff motivation, staffing levels, governance and compliance, development, and costs and revenue. These themes represented the measures that MHS believed measured key performance criteria in alignment with their organisational objectives.

Indicadores claves de desempeño y su aplicación en la gerencia estratégica de las empresas de salud / Key performance indicators and their application in the strategic management of healthcare companies

Introducción: La gerencia empresarial, a lo largo de la historia, se ha preocupado por alcanzar objetivos y metas mediante la utilización de estrategias con el fin de tratar de garantizar los réditos que le permitan seguir trabajando en el tiempo. El interés de lograr alcanzar la eficiencia empresarial ha sido clave para que los investigadores modernos hayan realizado importantes aportes a la epistemología de las ciencias administrativas. Surge entonces la pregunta en la mente de los administradores: ¿Es de importancia la aplicación de indicadores claves de desempeño en la gerencia estratégica de las empresas de salud? Los indicadores claves de desempeño, o KPIs por sus siglas en inglés, forman parte del conjunto de métricos que la administración moderna utiliza para saber si el negocio está logrando los objetivos y metas planteadas por la gerencia. El tablero de mando integral de Kaplan y Norton, desde su aparición en el año de 1992, ha sido también de gran valor para la gerencia estratégica empresarial. Objetivo: Presentar la importancia que tiene la utilización de los indicadores claves de desempeño al ser aplicados en la gerencia estratégica de las empresas de salud. Metodología: Basada en el paradigma cualitativo-descriptivo de investigación acción, el cual se sustentó en literatura científica publicada entre los años 2017 y 2021 apoyado en las plataformas Google Scholar y SciELO. Los criterios de inclusión fueron artículos y textos que abordaran los temas de: indicadores claves de desempeño, inteligencia de negocios, gerencia estratégica y tablero de mando integral. Resultado y Conclusiones: El continuo monitoreo del ambiente competitivo en el que la empresa está inmerso, permite la adaptación de los métricos de acuerdo con los cambios del entorno. En la medida en que los métricos permitan a la empresa volverse líquida, es decir, facilitar que se amolde a los cambios en el medioambiente económico, se facilitará la toma de decisiones de negocios eficaces y oportunas.

Introduction: Business management throughout history has been concerned with achieving objectives and goals, through the use of strategies in order to try to guarantee the revenues that allow it to continue operating over time. The interest in achieving business efficiency has been key for modern researchers to have made important contributions to the epistemology of administrative sciences. The question then arises in the minds of administrators: Is it important to apply key performance indicators in the strategic management of health companies? Key performance indicators, or KPIs for its acronym in English, are part of the set of metrics that modern management uses to know if the business is achieving the objectives and goals set by senior management. Kaplan and Norton's Balanced Scorecard, since its appearance in 1992, has also been of great value for strategic business management. Objective: To present the importance of the use of key performance indicators when applied in the strategic management of health companies Methodology: Based on the qualitative-descriptive and hermeneutical paradigm in the which was based on studies between 2017 and 2021 supported by the Google Scholar and SciELO platforms. The inclusion criteria were articles and texts that addressed the topics of: key performance indicators, business intelligence, strategic management and balanced scorecard. Results and Conclusions: The continuous monitoring of the competitive environment in which the company is immersed, allows the adaptation of the metrics according to changes in the environment. To the extent that the metrics allow the company to become liquid, that is, make it easier to adapt to changes in the economic environment, effective and timely business decision-making will be facilitated.

Engaging patients in balanced scorecard evaluation - An implication at Palestinian hospitals and recommendations for policy makers.

Introduction: A balanced scorecard (BSC) is a comprehensive performance evaluation (PE) tool. A recent review summarized that a balanced consideration of PE from six perspectives in hospitals must be considered: financial, customer, internal, external, knowledge and growth, and managerial. However, patients were rarely engaged in BSC implementations. This research aims to engage Palestinian patients in BSC implementation to develop recommendations for policy makers. Methodology: In this cross-sectional study, the BSC-PATIENT survey was distributed between January and October 2021. We evaluated patients' experiences and their attitudes toward BSC dimensions (BSCP ATT). The differences in evaluations based on admission status were analyzed using the Mann-Whitney U test. Causal relationships between patients' experiences and attitudes were analyzed using multiple linear regression. We tested the multicollinearity of the model. Path analysis was performed to understand the BSC strategic maps based on the Palestinian patients' evaluations. Results: Out of 1,000 surveys, 740 were retrieved. The mean scores for Palestinian patient experiences evaluation showed that the services experience factor had the highest score (87.7 ± 17.7), and the patient care experience factor had the lowest score (57 ± 34.5). Patient experiences collectively predicted 56.4% of the variance in the BSCP ATT. The experience factors of information (ß = 0.400, t = 13.543, P < 0.001), patient care (ß = 0.241, t = 8.061, P < 0.001), services (ß = 0.176, t = 6.497, P < 0.001), and building (ß = 0.177, t = 6.308, P < 0.001) had the highest impact on BSCP ATT. The price had only a weak negative influence (ß = -0.051, t = -2.040, P = 0.042). Accessibility to hospitals did not have any impact on BSCP ATT. Significant differences between inpatient and outpatients' evaluations in regard to experiences related to patient care (P = 0.042), services (P < 0.001), accessibility (P < 0.001), and BSCP ATT (P = 0.003) were found. Conclusion: BSC-PATIENT successfully engaged patients in BSC PE at Palestinian hospitals. This research 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 a two-way information communication with patients. Strong evidence for patient care, services, and building experiences role in improving patients' attitudes was found. Managers should enhance patients' feedback and engagement culture in Palestinian hospitals.

An Empirical Framework for Assessing the Balanced Scorecard Impact on Sustainable Development in Healthcare Performance Measurement.

Performance appraisal has become an essential tool for healthcare managers due to the frequent and rapid changes in the healthcare sector. Sustainable performance management implies increasing organizations' efficiency and effectiveness while considering all vectors of sustainability. This study examines the impact of digital transformation, accounting information systems, and strategic human resource management improvements on organizational performance and sustainable development. The paper uses the balanced scorecard (BSC) for organizational performance assessment. The paper proposes a theoretical model that integrates the traditional and digital information systems and human resources engagement with the BSC dimensions for sustainable organizational development. The theoretical model is tested in an empirical study involving a questionnaire-based survey of 387 employees with management experience in the healthcare sector. Based on structural equation modeling, the research results showed that the efficiency and effectiveness of strategic human resources management and the accounting information system significantly positively affect the BSC dimensions. Furthermore, the use of BSC in measuring organizational performance has significant effects on sustainable development, with the internal process dimension being the most influential.

Constructing internal audit quality evaluation index: evidence from listed companies in Jiangsu province, China.

Internal audit quality is the foundation for a company's survival and development across the world. As a result, global efforts have been made to develop a scientific and accurate evaluation index for internal audit quality. However, literature shows that existing internal audit quality evaluation indices have many flaws, such as a lack of systematic internal audit evaluation indicators, poor execution, and inability to identify priority areas. To address gaps in the literature, this study intended to construct an internal audit quality evaluation index utilizing the joint approaches of the Balanced Scorecard, Delphi Process, and Analytical Hierarchy Process. A systematic literature review, examination of companies' internal audit guidelines, Balanced Scorecard, and Delphi approaches resulted in a multilevel internal audit quality evaluation index with five dimensions (stakeholder satisfaction, stakeholder contribution, financial results, internal audit process, and learning and growth) and 36 indicators. The Analytical Hierarchy Process revealed that the most prioritized dimension is the internal audit process. The consistency ratio and evaluation feedback from the listed companies' internal auditors, management, and audit committee members revealed that the results are valid and reliable.

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

During the last few years, the interest in performance measurement increased within the healthcare sector. Due to the COVID-19 pandemic, healthcare systems needed to boost performance measurement systems to become more resilient and improve their capability in monitoring key performance indicators. Since the 1990s, the Balanced Scorecard (BSC) model has been widely used among private and public organizations as it is the most adopted model to measure performance. The current paper aims at understanding the evolution of BSC in healthcare. The systematic literature review has been carried out by searching keywords according to PRISMA guidelines. By analyzing papers through one classification of BSC adoption phases, the results reveal that studies focused mainly on the BSC design process, rather than BSC implementation, use, or review. However, there is no agreement about the perspectives to be adopted in healthcare. Concerning BSC implementation and use, on one side especially leadership, culture and communication enable the BSC implementation. On the other side, monitoring and strategic decision-making are the most widespread objectives for using BSC. Concerning BSC review, however, the paper highlights a need for additional research. Finally, the paper provides further research opportunities concerning the phases suitable for implementing a BSC in healthcare.

How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1-A Cross-Sectional Study.

Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors' convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument's psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs' and hospital characteristics.

Conceptual structure of balanced scorecard research: A co-word analysis.

The present research aims to examine the conceptual structure of balanced scorecard (BSC) research from its inception (1992) to the end of 2020. After a review of the BSC literature, co-word analysis and social network analysis are used to analyze the data. The results show that 3742 documents have been published between 1992 and 2020 with 2638 distinctive keywords. The most frequently used keywords are "Balanced Scorecard", "Management", "Performance", "Framework" and "Strategy". Moreover, the article "The Balanced Scorecard: Measures That Drive Performance" with 4253 citations, was the most frequently cited article and "Robert Kaplan" with 16 documents and 8063 citations was the top author in terms of citation count and the number of documents. The United States is the top country with 486 documents and 18,805 citations. In addition, the journal "Total Quality Management and Business Excellence" is the most prolific journal with 50 articles, and the journal "Harvard Business Review" with 7778 citations, is the top journal in the number of citations. "Islamic Azad University of Iran" is the top university in the world with 57 documents. The most common keyword in Asia, Europe, North America, South America, and Oceania is "Balanced Scorecard". The results of this study provide an overview of the state of BSC literature and can enable researchers to identify and develop ideas for future research.

Assessing Patient Experience and Attitude: BSC-PATIENT Development, Translation, and Psychometric Evaluation-A Cross-Sectional Study.

Health care organizations (HCO) did not consider engaging patients in balanced scorecard (BSC) implementations to evaluate their performance. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Two panels of experts participated in the item generation of BSC-PATIENT. Translation was performed based on guidelines. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. As a result, the scales had a highly adequate model fit in the EFA and CFA. The final best fit model in CFA comprised ten constructs with 36 items. In conclusion, BSC-PATIENT is the first self-administered questionnaire specifically developed to engage patients in BSC and will allow future researchers to evaluate the impact of patient experience on attitudes toward BSC perspectives, as well as to compare the differences based on patient and hospital characteristics.

Balanced Scorecard-Based Hospital Performance Measurement Framework: A Performance Construct Development Approach.

Introduction Despite the critical importance of hospital performance measurement, empirically validated hospital performance frameworks lack. The balanced scorecard is considered one of the most influential contributions in the performance measurement literature. Since the introduction of the balanced scorecard in the early 90s, many scholars have used a balanced scorecard to enable hospital performance measurement and improvement. Therefore, this study aimed to construct and validate a balanced scorecard-based hospital performance framework. Additional to the original four perspectives, the quality of care is added as a perspective for the balanced hospital scorecard. It reflects one of the key strategic objectives in any healthcare organization. Methods The study adopted a two-phase model to validate the framework empirically. The first is the exploratory phase, where feedback from academicians and professionals helped finalize the framework in the form of scale. In the second phase, the scale was tested for dimensionality, reliability, and validity. Results A total of 200 (81 responded, RR= 40%) senior managers working in Hamad Medical Corporation (HMC), the largest healthcare provider in Qatar, were surveyed. The content, convergent, and discriminant validities were established. The study conducted composite reliability and Cronbach's alpha tests for the reliability, and all variables were found to have alpha and composite reliability higher than 0.7. Conclusion The findings suggest that senior managers in HMC make a meaningful distinction between the five attributes of hospital performance. Findings, contributions, limitations, directions for future research, and managerial implications are all discussed.