<![CDATA[Indonesian hospitals face a dual challenge in the era of the National Health Insurance (JKN) and the Standard Inpatient Care Class (KRIS): financial pressure resulting from the INA-CBGs prospective payment scheme, which often fails to cover the actual costs of services, and the need for significant infrastructure investment to comply with the 12 KRIS criteria that must be implemented by 30 June 2025 at the latest. This article aims to synthesise empirical and conceptual evidence regarding the integration of the Balanced Scorecard (BSC), Lean Hospital and digital transformation as a comprehensive strategic management approach for hospitals in addressing these dual challenges. The method used was a literature review. The findings indicate that the BSC offers a balanced strategic framework through four interrelated performance perspectives (financial, customer, internal business processes, and learning and growth) linked by a logical causal chain, with internal process efficiency serving as the primary driver of financial performance and service sustainability. The implementation of Lean Hospital in priority areas such as inpatient workflows, bed management, JKN claims processing, and pharmaceutical logistics has been empirically proven to significantly reduce waste (by up to 70% in some studies), speed up service delivery times, and improve operational efficiency without compromising clinical quality. Digital transformation, driven by the mandate for Electronic Health Records (EHRs), the integration of the SATUSEHAT platform, and the electronic claims policy commencing in August 2026, serves as a critical enabler that strengthens the BSC–Lean synergy through the provision of real-time data, process automation, and predictive analytics for evidence-based decision-making. The integrated BSC–Lean–Digital model enables hospitals to translate abstract strategies into measurable operational actions, with concrete examples such as reducing the backlog of claims through standardised coding and electronic claims automation, or improving KRIS compliance through the redesign of the admission–transfer–discharge workflow supported by a ward capacity alert system. Hospitals that successfully adopt this integrated approach will gain a competitive advantage in the form of improved cost efficiency, higher quality of care, increased patient satisfaction and greater financial resilience in the face of policy fluctuations. Conversely, hospitals that fail to adapt risk chronic claims deficits, regulatory non-compliance, a decline in service quality, and a loss of trust from the public and funding partners.]]>
