Balanced Scorecard for Hospital Performance Evaluation: A Systematic Review of Implementation, Outcomes, and Challenges: A PRISMA-Guided Review of Hospital Performance Measurement Frameworks

Arya Brahmanta (Rumah Sakit Gigi dan Mulut Nala Husada, Universitas Hang Tuah Surabaya)
Ansarul Fahruda (Department of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Indonesia)
Annisa Nurida (Department of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surabaya)
Pipit Festi Wiliyanti (Department of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Indonesia)
Caecilia Indarti (Department of Hospital Administration, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Indonesia)
Cakrawartya Ramadhi (Department of Dental Public Health, Faculty of Dentistry, Nala Husada Dental Hospital, Universitas Hang Tuah, Surabaya, Indonesia)

Journal of Global Research in Public Health
Vol. 11 No. 1 (2026): June

Hospitals are required to improve service quality, cost efficiency, patient safety, and user satisfaction in an increasingly complex healthcare environment. Traditional performance measurement systems that focus mainly on financial indicators are often insufficient to evaluate overall organizational performance. The Balanced Scorecard (BSC) offers a comprehensive framework by integrating four perspectives: financial, customer, internal business processes, and learning and growth. This study aimed to review the implementation of BSC in hospitals and identify its benefits, outcomes, and challenges. A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, Google Scholar, and DOAJ using the keywords “balanced scorecard,” “hospital performance,” “healthcare management,” and “BSC in hospital.” Articles published between 2010 and 2025 in English or Indonesian were screened according to predefined inclusion and exclusion criteria. Of 312 records identified, 14 studies met the eligibility criteria and were included in the final analysis. The findings showed that BSC positively contributed to hospital performance across all four perspectives. Financial improvements included better cost control, budget management, and operational efficiency. From the customer perspective, hospitals reported higher patient satisfaction and service quality. Internal process improvements included reduced waiting times, enhanced clinical quality, and more efficient workflows. In the learning and growth perspective, BSC supported staff development, organizational culture, employee retention, and professional competence. However, implementation challenges remained, including limited data quality, resistance to change, inadequate information systems, and insufficient understanding of BSC concepts. In conclusion, BSC is a comprehensive and adaptable framework for hospital performance measurement that supports strategic management, continuous quality improvement, and organizational sustainability.