Exploring the Use of Balanced Scorecards in a Swedish Health Care Organization

Abstract: Due to an extensive decentralization in the County Council of Östergötland during the 1980s, the demands on follow-up reports have increased on the production units. In order to support the units in following up their organizations, the board of the County Council decided to implement Total Quality Management in the beginning of the 1990s. As a part of the program, the QUL concept was introduced to provide the County Council with a comprehensive description of the production units’ activities. In 2001 the County Council decided to implement the Balanced Scorecard (BSC) as a new way of following up the units’ results. The BSC implementation has led to that all production units write their follow-up reports according to the perspectives suggested in the BSC framework. The head of the production units are responsible for the dissemination and implementation of the BSC in their own units.The present research is conducted on commission from the Federation of Swedish County Councils. The purpose of the thesis is to increase the understanding of the use of the BSC in an organization in the Swedish health care and medical services. Two research questions derive from the purpose: (1) How is the BSC designed, implemented and used in the organization? (2) What factors enable or constrain the use of the BSC in the organization?Findings from the case study show that the BSC is used in the annual planning, in reporting measures to superiors and in following up the activities in the health care organization. The BSC is also used in discussions between employees, to disseminate information within and outside the organization, to create orderliness and understanding of the annual activities, and in developmental activities. The findings indicate that the BSC has been adapted to the current conditions of the organization with regard to the existing terminology and organizational structures. The BSC is not primarily used as a strategic management system, but rather as an information system that aims to communicate measurable information within and outside the organization.Several categories of factors that enable or constrain the use of the BSC in a health care organization are identified. The autonomy of the department and units enables people to develop their own scorecards without considerable influence from superiors. The emphasis on employees’ participation is also identified as an important aspect in making people accept the new concept. The way the introduction of the BSC was dealt with and the department’s prior experiences with the Swedish Quality Award have influenced the acceptance and use of the BSC. In addition, the case shows that change agents play a major role in how the BSC is used in the organization today. Several adaptations have been made to current conditions, that both enable and constrain the use of the BSC in the health care organization.