OBJECTIVES: We intended to identify all the internal subdimensions used in balanced scorecard (BSC) implementations. Then to assess the impact of the pandemic on the internal subdimensions at health care organizations (HCOs).

METHODS: We performed a systematic review in accordance with PRISMA guidelines to find all internal 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 internal 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, 240 internal KPIs were extracted. Categorization and regrouping of these KPIs resulted in 4 major-dimensions under which 15 internal subdimensions were defined. The error-free and safety major-dimension comprised the mortality, errors, accidents and complications, infection control (IC) index, health waste (HW) management, and safety standards subdimensions. The efficiency and effectiveness major-dimension included the number of admissions and visits, efficiency and utilization, improvement ratios, and occupancy rate subdimensions. The availability and quality of supplies and services major-dimension composed of the medications, supplies and equipment, and products and services subdimensions. The time major-dimension contained the operation processing time, waiting time, and length of stay subdimensions. Almost all of these subdimensions were found to be negatively affected, except the safety standards, which improved during the pandemic due to better IC adherence. Although HW management has been extensively investigated, further investigation is needed. Additionally, the mortality, supplies and equipment, and products and services subdimensions were not sufficiently investigated in the performance evaluations of HCOs.

CONCLUSIONS: Most internal subdimensions were negatively affected during the pandemic. Future research on how to improve the performance of the internal subdimensions during the pandemic is still required and encouraged.