<![CDATA[The implementation of the Balanced Scorecard (BSC) serves as a crucial instrument in aligning strategic planning with service quality in public hospitals, yet the empirical effectiveness of managerial performance within this dynamic still requires validation. This study aims to analyze the impact of Balanced Scorecard-based planning (X) on Managerial Performance (Y1) and Service Quality (Y2) at UPTD RSD dr. H. Soemarno Sosroatmodjo Tanjung Selor. This quantitative research involved 50 key respondents occupying internal management positions (structural officials, heads of installations, and room heads). Data collection utilized a structured questionnaire instrument that was tested and proven valid and reliable. The path analysis results demonstrated that Balanced Scorecard-based planning has a positive and significant effect on Managerial Performance and exerts a highly dominant direct effect on Service Quality. Conversely, Managerial Performance was found to have no significant impact on Service Quality, thereby failing to act as a mediating (intervening) variable, with a negligible indirect effect value. The non-significance of this mediating pathway confirms the phenomenon of functional separation ("institutional decoupling"). The respondents' managerial performance is heavily oriented toward fulfilling bureaucratic administrative duties, while clinical service quality on the ground operates independently and on "autopilot," guided by strict national accreditation standards (KARS), medical professional codes, and BPJS Healthcare regulations. The strategic implication of this study emphasizes that the best investment for the management is to directly strengthen the consistency of the organization's BSC-based operational system that enhances patient comfort, rather than partially focusing on reforming the personal administrative bureaucracy of individual managers.]]>
