Exploring the use of the Balanced Scorecard (BSC) in the healthcare sector of the Kingdom of Saudi Arabia: Rhetoric and reality. Evaluate understanding the five perspectives of the BSC. Evaluating the understanding of linkage between the BSC and strategy of the hospital. The reality of the implementation of BSC in KFSH

Abstract

This thesis aims to evaluate the implementation of the Balanced Scorecard (BSC) based on a case organization; the King Faisal Specialist Hospital and Research Centre (KFSH-RC). The study is an exploratory investigation. Understanding BSC perspectives is important for academic comprehension and is crucial for successful implementation. BSC at KFSH-RC includes five main perspectives: Quality of Care; Medical Care; Employees; Financial; and Education and Research (learning and growth). The thesis tackles two main anecdotal, practice-based arguments: BSC helps achieve business strategy, and the implementation of BSC has often fallen short of the assertions made about its potential for impact. A case study with a triangulation approach is justified and pursued. This study contributes to the literature in different ways. The application of the BSC has received limited attention in healthcare organisations in general, and in the Middle East and North Africa (MENA) in particular, and may be one of the first to explore such issues, across management and professional groups, to research BSC in the healthcare organisation in the KSA. It distinguishes between the understanding of financial and non-financial perspectives; and the researcher has developed a conceptual framework, which reflects the main elements of BSC implementation. Quantitative data analysis from the case study indicates that staff members at the KFSH possess only a shallow understanding of various BSC perspectives. The study revealed a consistent lack of understanding of BSC by the department employees, due to their lack of interest. The results show that performance measures following the implementation of BSC created no significant improvement. It also confirms that even some senior managers face difficulties understanding BSC perspectives. The qualitative-based findings indicate that the level of understanding of BSC for clinical services is not significantly different from that for non-clinical services; staff members of the KFSH resist the implementation of BSC in the early stages; and there is ¿autocratic¿ leadership style at the KFSH inhibited the flow of information. The power distance and autocratic leadership style, in combination with an inadequate launch of BSC, fail to follow the implementation steps recommended by both Kaplan and Norton (2001a) and Kotter (1996). These organisational dynamics, it will be argued, are understated in the original BSC methodology, a view consistent with the findings of Woodley (2006) and may be especially so in environments with strong professional norms such as hospitals. The implications for the study and practice of non-profit organisations wishing to adopt methodology developed initially in a commercial context, is considered.