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

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

MAPPING LEAN EXPERIENCES AND EMERGING CONNECTIONS WITH CLINICAL RISK MANAGEMENT IN ITALIAN CONTEXT

Purpose\u2013The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with clinical risk management (CRM). Design/methodology/approach\u2013 After introducing Italian healthcare system and its main challenges, relevant Italian experiences have been searched investigating regional health plans (RHPs), managerial reports, books, workshops, conference proceedings and hospital web sites. The degree of experience of each Italian region has been first studied. Further, field of applicability, objectives, tools, practices and results of the projects with first signs of HLM and CRM integration have been analyzed. Findings\u2013Although interest in new managerial approaches is spreading in almost all the territory and new managerial solutions are fostered in many RHPs, HLM projects are implemented patchy in Italy. For what regards HLM projects with CRM connections, the Italian context seems aligned with the international one, apart from few features. First indications for the implementation of HLM projects with CRM connections emerged. Originality/value\u2013Healthcare systems are facing multiple challenges in a context where public funds decrease but quality of care must be guaranteed. Combining different managerial approaches could solve these issues. In this research, for the first time, a map about Italian HLM adoption has been drawn, and Italian HLM projects with CRM connections have been analyzed. The results constitute one of the first contributions useful to develop guidelines for the implementation of projects pursuing efficiency, quality and safety objectives

Abordagem Lean no contexto da gestão de riscos nas organizações de saúde: Uma revisão sistemática de literatura

As organizações de saúde vêm enfrentando desafios diante dos altos custos e baixa eficiência dos serviços de saúde, causados pelo crescimento e valorização dos serviços. O crescimento dos custos, maior do que as receitas e os prejuízos causados por erros evitáveis levam a procura por soluções. O Lean healthcare é um sistema de gestão que tem como foco a eliminação de desperdícios e a criação de valor, gerando melhorias dos processos, podendo ser uma solução para as dificuldades e problemas gerados na diminuição da qualidade do serviço prestado, tal como o aumento do risco para o paciente. Este estudo tem por objetivo analisar o estado da arte da literatura centrada na abordagem Lean no contexto da gestão do risco, nas organizações de saúde, e identificar novas oportunidades de investigação, evidenciando possíveis linhas de investigações futuras. Foi realizada uma revisão sistemática de literatura (systematic literature reviews (SLR)), a fim de coordenar a diversidade de conhecimento numa investigação acadêmica específica, o que permitiu mapear e avaliar publicações existentes e identificar questões de pesquisa a desenvolver. Baseado nos resultados, foram identificadas cinco principais áreas de investigação: 1) gestão do risco orientada para a segurança dos pacientes; 2) gestão do risco orientada para a segurança dos colaboradores; 3) importância das atitudes e comportamentos nos projetos de redução do risco; 4) ferramentas Lean usadas na gestão do risco em saúde e 5) Integração de abordagens. Esta SLR sugere que no contexto da gestão dos riscos nas organizações de saúde, a abordagem Lean apresenta benefícios quanto à segurança e permite ainda melhorias nos processos, na eficiência da utilização de recursos, nos indicadores de qualidade e na satisfação profissional. Desta forma, a abordagem Lean é um modelo de gestão inovadora e de sucesso, contribuindo para melhorias na qualidade e eficiência, no controlo de custos, na redução de desperdícios, na gestão do risco e na prestação de cuidados ideais, agregando valor para o paciente.Healthcare organizations have been facing challenges due to the high costs and low efficiency of health services, caused by the growth and valuation of services. The growth of costs, greater than the revenues and the losses caused by avoidable mistakes, lead to the search for solutions. Lean healthcare is a management system that focuses on eliminating waste and creating value, generating process improvements, which can be a solution to the difficulties and problems generated in the reduction of quality in the service provided, as well as the increase in risk to the patient. This study aims to analyse the state of the art in the literature centred on the Lean approach in the context of risk management in healthcare organizations and to identify new research opportunities, highlighting possible lines of future investigation. A systematic literature review (SLR) was carried out in order to coordinate the diversity of knowledge in a specific academic investigation, which allowed the mapping and evaluation of existing publications and identifying research issues to be developed. Based on the results, five main research streams were identified: 1) risk management oriented towards patient safety; 2) risk management oriented towards employee safety; 3) importance of attitudes and behaviours in risk reduction projects; 4) Lean tools used in healthcare risk management and 5) Integration of approaches. This SLR suggests that, in the context of risk management in healthcare organizations, the Lean approach has benefits in terms of safety and also allows for improvements in processes, in the efficiency of the use of resources, in quality indicators and in professional satisfaction. In this way, the Lean approach is an innovative and successful management model, contributing to improvements in quality and efficiency, cost control, waste reduction, risk management and optimal care delivery, adding value to the patient