Analysis of the Balanced Scorecard's External Subdimensions in Health Care Organizations During the COVID-19 Pandemic

OBJECTIVES: We intended to review all the external subdimensions used in balanced scorecard (BSC) implementations and then to assess the impact of the pandemic on the external subdimensions at health care organizations (HCOs).

METHODS: First, we performed a systematic review in accordance with PRISMA guidelines to find all external key performance indicators (KPIs) used in BSC implementations from the time of inception until October 2020 in PubMed, Embase, Cochrane, Google Scholar databases, and Google's search engine. Second, we searched for independent studies using the resulting external subdimensions with the COVID-19 keyword in Google engine and Google Scholar until June 2021.

RESULTS: Out of 4031 studies, 36 implementations remained. From these, 73 external KPIs were extracted. Categorization of KPIs resulted in 2 major-dimensions. HCO’s building and community under which another 3 subdimensions were defined: privacy, corporate social responsibility (CSR), and market share. HCO’s building was extensively investigated and improved during the pandemic to increase the capacity and decrease the waiting time. However, researchers did not sufficiently investigate the ease of access to HCOs during the pandemic. Moreover, patient privacy was negatively affected in some countries, and due to breaching patient privacy in some countries, this may have stigmatized those patients. The political conflict during the pandemic in the Occupied Palestinian Territories was referred to impose a double epidemic effect on its health system. On the other hand, factors such as exemptions offered by HCO for poor patients, CSR, patient privacy concerns, and HCO market shares in COVID-19 still need more investigation.

CONCLUSIONS: Some of the external subdimensions were negatively affected during the pandemic, such as patient privacy, while others were positively affected, such as HCO building. However, researchers are encouraged to perform further assessments of how to improve the patient privacy, CSR and market share subdimensions during the pandemic.