Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Balanced and Imbalanced Performance Evaluation using Balanced Scorecard and Analytic Hierarchy Process

Document Type : Original Article

Authors
Ali Vafaee Najar 1
Seyed Saeed Tabatabaee 1
Elaheh Houshmand 1
Hosein Ebrahimipour 1
Hadi Zomorodi Niat 2
1 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/psj.2021.44671.1254
Abstract
Introduction:
This study aimed to compare the performance evaluation of a selected hospital through weighting and not weighting the indices using a hybrid approach.
Materials and Methods:
This mixed-method study was conducted in a Specialized Hospital in Mashhad, Iran. In the group discussion sessions of the scorecard team, a list of performance indices was prepared in four perspectives using a balanced scorecard approach. The indices were selected using the Delphi method and measured in the hospital afterward. In the first method, the percentage of realization of each index was measured based on the expected value of the index in the hospital, and the overall performance score was obtained. In the second method, the weight of each perspective and index was calculated using the standard hierarchy analysis questionnaire, and the coefficient of the significance of each index and perspective was considered in hospital performance based on the expected quantity of the index. Eventually, the performance of the hospital was compared using these two methods.
Results:
Based on the results obtained from the application of the weighting method, the processes and customer perspectives obtained the highest and the lowest scores, respectively. The score of the hospital’s performance in this method was obtained at 89.27%. However, in the method without weighting, the processes and financial perspectives obtained the highest and the lowest scores, respectively, and the score of the hospital’s performance was estimated at 82.63%.
Conclusion:
The score of perspectives and indices will be different when the significance of perspectives and indices are ignored, which results in an incorrect (downgraded) estimation of the organization performance.
Keywords
Analytic hierarchy process
Balanced scorecard
Hospital
Performance evaluation
  1. Chuang CL, Chang PC, Lin RH. An efficiency data envelopment analysis model reinforced by classification and regression tree for hospital performance evaluation. Journal of medical systems. 2011 Oct; 35(5): 1075-83. PubMed PMID: 20878210. Epub 2010/09/30. eng.
  2. Digiesi S, Mossa G, Ranieri L, Rubino S, editors., editors. An Integrated Approach Based On Balanced Scorecard and Analytic Hierarchy Process for Strategic Evaluation of Local Healthcare Agencies. Proceeding of the International Symposium on the Analytic Hierarchy Process; 2011.
  3. Ghandehary N, Esmaelian M, Teimouri H, Ghalamkari S. Evaluating the Performance of Noor-Ali Asghar Hospital in Isfahan, Iran, Using a Combination of Balanced Score Card and MACBETH. Health Inf Manage. 2017; 14(2):58-64.
  4. Lin Z, Yu Z, Zhang L. Performance outcomes of balanced scorecard application in hospital administration in China. China Economic Review. 2014 2014/09/01/; 30:1-15.
  5. Azar A, Mohammadi Y. Developing a mathematical model for hospitals performance evaluation: A hybrid approach of FHNBSC, SAW and LINMAP. J Health Syst Res. 2014; 10(3):2-10.
  6. Pietro GL, Giorgio V. The balanced scorecard in health care: a multilevel latent variable approach. Journal of Modelling in Management. 2012; 7(1):38-58.
  7. Yüksel I, Dagdeviren M. Using the fuzzy analytic network process (ANP) for Balanced Scorecard (BSC): A case study for a manufacturing firm. Expert Syst Appl. 2010; 37(2):1270-8.
  8. Bartolome-Benito E, Jimenez-Carraminana J, Sanchez-Perruca L, Bartolome-Casado MS, Dominguez-Mandueno AB, Marti-Argandona M, et al. [Development and evolution of a balanced scorecard in primary health care: Lessons learned]. Revista de calidad asistencial: organo de la Sociedad Espanola de Calidad Asistencial. 2017 Jan - Feb; 32(1):40-PubMed PMID: 27268870. Epub 2016/ 06/ 09. Desarrollo y evolucion de UN cuadro de mando integral en atencion primaria: lecciones aprendidas. Spa.
  9. Bruce G, Tian G. Lives in the balance: an analysis of the balanced scorecard (BSC) in healthcare organizations. International Journal of Productivity and Performance Management. 2007; 57(1):6-21.
  10. Gauld R, Al-Wahaibi S, Chisholm J, Crabbe R, Kwon B, Oh T, et al. Scorecards for health system performance assessment: the New Zealand example. Health policy (Amsterdam, Netherlands). 2011 Dec; 103(2-3):200-8. Pub Med PMID: 21723641. Epub 2011/ 07/ 05. eng.
  11. Grigoroudis E, Orfanoudaki E, Zopounidis C. Strategic performance measurement in a healthcare organization: a multiple criteria approach based on balanced scorecard. Omega: the international journal of management science. 2012; 40(1, (1)):104-19. eng.
  12. Kunz H, Schaaf T. General and specific formalization approach for a Balanced Scorecard: An expert system with application in health care. Expert Systems with Applications. 2011 Mar; 38(3):1947-55. PubMed PMID: WOS: 000284863200074. English.
  13. Nippak PM, Veracion JI, Muia M, Ikeda-Douglas CJ, Isaac WW. Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital. Health Informatics Journal. 2016; 22(2):120-39. PubMed PMID: 24948412.
  14. Behrouzi F, Shaharoun AM, Ma'aram A. Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian health review: a publication of the Australian Hospital Association. 2014 May; 38(2):208-17. PubMed PMID: 24589328. Epub 2014/03/05. eng.
  15. Kaplan RS. Conceptual Foundations of the Balanced Scorecard. In: Chapman CS, Hopwood AG, Shields MD, editors. Handbooks of Management Accounting Research. 3: Elsevier; 2009. p. 1253-69.
  16. Bigliardi B, Ivo Dormio A. A balanced scorecard approach for R&D: evidence from a case study. Facilities. 2010; 28(5/6):278-89.
  17. Soderberg M, Kalagnanam S, Sheehan N, Vaidyanathan G. When is a balanced scorecard a balanced scorecard? 2011. 688-708 p.
  18. 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 2012/10/01/; 65(10): 919-27.
  19. Catuogno S, Arena C, Saggese S, Sarto F. Balanced performance measurement in research hospitals: the participative case study of a hematology department. BMC Health Services Research. 2017 August 03; 17(1):522.
  20. El-Jardali F, Saleh S, Ataya N, Jamal D. Design, implementation and scaling up of the balanced scorecard for hospitals in Lebanon: policy coherence and application lessons for low and middle-income countries. Health policy (Amsterdam, Netherlands). 2011 Dec; 103(2-3):305-14. PubMed PMID: 21658787. Epub 2011/06/11. eng.
  21. Journeault M. The Integrated Scorecard in support of corporate sustainability strategies. Journal of environmental management. 2016 Nov 1; 182:214-29. PubMed PMID: 27479238. Epub 2016/08/02. eng.
  22. Lee AHI, Chen W-C, Chang C-J. A fuzzy AHP and BSC approach for evaluating performance of IT department in the manufacturing industry in Taiwan. Expert Systems with Applications. 2008 2008/01/01/; 34(1):96-107.
  23. Saaty TL. The analytic hierarchy process: planning, priority setting, resource allocation. New York; London: McGraw-Hill International Book Co.; 1980.
  24. Bentes AV, Carneiro J, da Silva JF, Kimura H. Multidimensional assessment of organizational performance: Integrating BSC and AHP. Journal of Business Research. 2012 2012/12/01/; 65(12):1790-9.
  25. Chan Y-CL. An Analytic Hierarchy Framework for Evaluating Balanced Scorecards of Healthcare Organizations. Canadian Journal of Administrative Sciences / Revue Canadienne des Sciences de l'Administration. 2006; 23(2):85-104.
  26. Álvarez Pérez C, Rodríguez Montequín V, Ortega Fernández F, Villanueva Balsera J. Integrating Analytic Hierarchy Process (AHP) and Balanced Scorecard (BSC) Framework for Sustainable Business in a Software Factory in the Financial Sector. Sustainability. 2017; 9(4):486. PubMed PMID: DOI: 10.3390/su9040486.
  27. Hooshmand E, Zomorodi Niat H, Ebrahimipour H, Esmaili H, Vafaee Najar A. Designing a Performance Evaluation Model Based on Balanced Score Card and Analytic Hierarchy Process Methods: Montaserieh Hospital. Health Scope. 2018; 7(2):e80342. Epub 2018-05-30. en.
  28. Yaghoobi T, Haddadi F. Organizational performance measurement by a framework integrating BSC and AHP. International Journal of Productivity and Performance Management. 2016; 65(7):959-76.
  29. Zomorrodi-niat H, Ebrahimipour H, Hooshmand E, Vafaee-najar A. Designing a Strategy Map with Balanced Scorecard Approach (A Case Study in Montaserieh Hospital). Manage Strat Health Syst. 2017; 2(3):80-173.
  30. Vafaee-najar A, Ebrahimipour H, Houshmand E, Zomorrodi-niat H. Identification and Prioritization of Hospital Performance Evaluation Indices by Combination of Balanced Scorecard and Delphi. NAVIDNO. 2018; 21(66):1-11.
  31. Kaplan RS, Norton, D.P. Using the balanced scorecard as a strategic management system: Harvard Business Review; 1996.
  32. Saaty T. A Scaling Method for Priorities in Hierarchical Structures1977. 234-81 p.
  33. Saaty T. How to Make a Decision: The Analytic Hierarchy Process 1990. 9-26 p.
  34. Alimohamadiyan e, shafiee M. A fuzzy multi-criteria decision approach for performance evaluation and improve the gaps among Shiraz University of Medical Sciences’ teaching hospitals based on balanced score card approach. Razi Journal of Medical Sciences. 2016; 22(140): 12-24. eng.
  35. Wu C-R, Chang CW, Lin H-L. A fuzzy ANP-based approach to evaluate medical organization performance. International Journal of Information and Management Sciences. 2008; 19(1):53-74.
  36. Santos    Mard,    Salomon    VAP,   Marins FAS. Analytic Network Process And Balanced Scorecard Applied To The Performance Evaluation Of Public Health Systems. Pesquisa Operacional. 2015; 35:353-61.
  37. Wang CH, Lu IY, Chen CB. Integrating hierarchical balanced scorecard with non-additive fuzzy integral for evaluating high technology firm performance. Int J Prod Econ. 2010 Nov; 128(1):413-26. PubMed PMID: WOS: 000284134600041. English.
  38. Kucukaltan B, Irani Z, Aktas E. A decision support model for identification and prioritization of key performance indicators in the logistics industry. Comput Hum Behav. 2016 Dec; 65:346-58. PubMed PMID: WOS: 000386986000037. English.
  39. Wu WH, Lin CT, Peng KH. Determination of a hospital management policy using conjoint analysis in the analytic network process. Quality & Quantity. 2009 January 01; 43(1):145-54.


 

 

 

 

Journal of Patient Safety & Quality Improvement
Volume 9, Issue 2
Spring 2021
Pages 79-90