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


  • Frida Betto

    (Department of Industrial Engineering, University of Padua, 35122 Padua, Italy)

  • Alberto Sardi

    (Department of Management, University of Turin, 10124 Turin, Italy)

  • Patrizia Garengo

    (Department of Industrial Engineering, University of Padua, 35122 Padua, Italy)

  • Enrico Sorano

    (Department of Management, University of Turin, 10124 Turin, Italy)


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.

Suggested Citation

  • Frida Betto & Alberto Sardi & Patrizia Garengo & Enrico Sorano, 2022. "The Evolution of Balanced Scorecard in Healthcare: A Systematic Review of Its Design, Implementation, Use, and Review," IJERPH, MDPI, vol. 19(16), pages 1-22, August.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:16:p:10291-:d:891746

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    2. Anca Antoaneta Vărzaru, 2022. "An Empirical Framework for Assessing the Balanced Scorecard Impact on Sustainable Development in Healthcare Performance Measurement," IJERPH, MDPI, vol. 19(22), pages 1-17, November.

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