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A Balanced Scorecard for Maximizing Data Performance

A good performance monitoring system is crucial to knowing whether an organization's efforts are making their data capabilities better, the same, or worse. However, comprehensive performance measurements are costly. Organizations need to expend time, resources, and personnel to design the metrics, to gather evidence for the metrics, to assess the metrics' value, and to determine if any actions should be taken as a result of those metrics. Consequently organizations need to be strategic in selecting their portfolio of performance indicators for evaluating how well their data initiatives are producing value to the organization. This paper proposes a balanced scorecard approach to aid organizations in designing a set of meaningful and coordinated metrics for maximizing the potential of their data assets. This paper also discusses implementation challenges and the need for further research in this area.

Introduction

Management and measurement are closely intertwined. Peter Drucker observed that organizations need feedback such as measurements to know whether they should stick to their current set of plans or whether it is time to change course and try something different (Zak, 2013 ). However, designing a measurement system to provide useful feedback is challenging. Redman ( 2005 ) noted that building a successful measurement system for data requires organizations to first identify the business requirements driving the need for measurement and how those metrics should be defined.

Moreover, when firms are trying to understand a situation as complex as how data is being managed and used to create value in their organization, the quantity and quality of metrics required to gain a full picture becomes even more daunting. Seiner ( 2016 ) described data governance as “the practice of applying formal accountability and behavior to assure the quality, effective use, compliance, security, and protection of data.” One need only consult several popular data governance frameworks to see the breadth of potentially measurable areas that data governance encompasses ( Table 1 ).

A sample of data governance frameworks and their major components.

Furthermore, data governance is only one aspect of what organizations should track about their data. Companies also want to know how best to monetize their data. In his book, Infonomics, Laney ( 2018 , p. 29) lists a variety of ways for how organizations can use data for generating value.

• Increasing customer acquisition/retention
• Creating a supplemental revenue stream
• Introducing a new line of business
• Entering new markets
• Enabling competitive differentiation
• Bartering for goods and services
• Bartering for favorable terms and conditions, and improved relationships
• Defraying the costs of information management and analytics
• Reducing maintenance costs, cost overruns, and delays
• Identify and reducing fraud and risk
• Cashing in on improved business performance
• Improving citizen well-being.

Finally, there is growing realization that in order for organizations to achieve the full potential of their data, they need to invest in the data literacy of their workforce. According to Panetta ( 2021 ), Gartner defines data literacy as “the ability to read, write and communicate data in context, including an understanding of data sources and constructs, analytical methods and techniques applied, and the ability to describe the use case, application and resulting value.” Without employees possessing the necessary data, skills, tools, and motivation to take on projects that generate business value from data, organizations lack the environmental readiness needed for successful data monetization (Pigni et al., 2016 ).

Despite these complexities, organizations cannot afford to ignore measuring the performance of their data initiatives. The lack of a comprehensive data performance evaluation system means an impaired ability for organizations to manage their data assets which has serious consequences.

• Difficulties retaining the Chief Data Officer. The chief data officer (CDO) is a senior executive responsible for the utilization and governance of data across the organization (Zetlin and Olavsrud, 2020 ). A recent survey by NewVantage Partners estimated that approximately 60% of organizations have hired a CDO (Bean, 2020 ). Despite the growing prominence of CDOs in corporate c-suites, many of these individuals are struggling to find success as evidenced by CDOs have one of the highest turnover rates among c-level executives with an average job tenure of ~2.5 years (DataKitchen, 2018 ). Bennett ( 2016 ) identified three major obstacles facing CDOs: (1) Organizational lack of understanding of the CDO role including a lack of focus in defining the most important initiatives; (2) Lack of stakeholder involvement and support along with a lack of resources and funding to support the CDO; and (3) Insufficient authority to execute responsibilities. A better system for coordinating data objectives, measures, and initiatives would help organizations to give their business leaders a clearer sense of expectations and responsibilities for data.
• Difficulties maintaining compliance with data privacy and protection policies. Organizations need to understand who is using their data, how the data is being used and shared, and where the data is being stored (Brockman, 2020 ). Organizations need to have robust data governance in place to ensure that they have the policies, oversight, training, and systems in place to adequately protect their data and to ensure that their data complies with security and privacy regulations.
• Difficulties reducing the operational costs of gathering, organizing, and sharing data. Better data governance has been shown to help reduce data duplication, strengthen data integration between applications, consolidate data storage, and improve data quality for faster, more reliable decision making (Sia Partners, 2020 ). Organizations need to evaluate their data governance efforts along with their data quality, data infrastructure, and data services to ensure their data operations are working at desired levels.

Articulating a clearer vision of critical data performance objectives is the first step to building a measurement system to support organizations' efforts to be more competitive with their data. To address this challenge, this paper proposes using a balanced scorecard management system that is specifically designed for maximizing the value of an organization's data assets. The rest of this paper is organized as follows. Section Balanced Scorecards gives a brief history of the use of balanced scorecards. Section Designing a Balanced Scorecard for Data Performance discusses what senior leaders should consider in designing a master balanced scorecard for data performance. Section Implementation Challenges and Closing Thoughts outlines the next steps necessary to implement the balanced scorecard approach throughout the organization along with plans for future research in this area.

Balanced Scorecards

Kaplan and Norton ( 1992 ) developed the balanced scorecard (BSC) in the early 1990s as a management system that views an organization from several different perspectives in order to provide a more complete picture of performance. The balanced scorecard approach addressed the concern that organizations were placing too much emphasis on the results of financial performance, and not enough emphasis on the aspects of the business that lead to financial performance such as customer satisfaction and efficient business operations or the aspects of the business that lead to future financial performance such as learning and growth. The balance scorecard approach helps senior managers to think through their competing agendas to better identify the different strategies in play (ex. serving customers, reducing waste, increasing revenue) and how to work together to achieve results that benefit the organization as a whole and not just one area of the firm (Kaplan and Norton, 1992 ).

Using the balanced scorecard management system ( Figure 1 ), senior leaders choose the perspectives that best define the crucial areas necessary for sustaining business success. For each perspective, senior leaders identify a set of essential goals/objectives which further detail how the organization plans to achieve success. Each goal is associated with typically one or two key measures for evaluating how well the organization is reaching that goal. Further iterations of the scorecard include additional details such as the desired target for each metric, the current value for the metric, initiatives for improvement, and the person or group responsible for tracking that metric.

The balanced scorecard links performance measures (Kaplan and Norton, 1992 ).

One of the main selling points of the balanced scorecard management system is that it is highly adaptable. The perspectives of the classic balanced scorecard can be changed to fit a wide variety of sectors including education, banking, airlines, manufacturing, healthcare, government, and non-profits. As a result, the balanced scorecard approach has been widely adopted by organizations. Hickman ( 2012 ) estimated that balanced scorecards are in use by 70% of companies around the world. There are also numerous software packages (both open source and vendor) available to support the implementation of a balanced scorecard management system.

Lastly, it is important to note that the balanced scorecard is a management system that requires intensive organizational commitment. In their study of Australian firms that had adopted the balanced scorecard approach, Chavan ( 2009 ) observed that to be successful, organizations had to overcome several obstacles. First, senior leadership had to reach a consensus as to what the master scorecard should look like for the organization. Next, the various business units needed to develop their unit scorecards whose objectives needed to align and contribute to the master scorecard. This process is then repeated at the department level and even at the individual level (e.g., employee performance appraisals) to ensure that all parties in the organization are working in integrated harmony to optimize business performance. Chavan ( 2009 ) concluded that organizations could achieve significant results using the balanced scorecard approach, but it requires leadership, communication, consensus, and accountability to be successful.

Designing A Balanced Scorecard For Data Performance

In Laney's ( 2018 , p. 1–4) book, Infonomics, he describes an infosavvy organization as one where business leaders can fully utilize information as a corporate asset, information is fully accessible to those who have a legitimate need, and the value of information assets can be measured. When it comes to using a balanced scorecard approach to assist organizations in achieving “infosavvy” status, the literature is sparse. A February 2022 literature review of Google Scholar using the search terms “scorecard” and “data” in the title yielded 122 results. The vast majority of these articles discussed various data issues with balanced scorecards such as improving performance assessment through techniques like data envelopment analysis, addressing data quality issues that impair the accuracy of performance metrics, and examining how big data systems could help automate the gathering of scorecard measures. Only four articles dealt with using balanced scorecards to improve data performance and those were in the context of assessing the success of a single data warehouse or similar large data store (Bensberg, 2003 ; Toomanian et al., 2011 ; Rahman, 2013 ; Martins and Belo, 2017 ). For organizations interested in a more ambitious balanced scorecard management system to help them maximize the performance across a wide portfolio of data assets, senior leaders must begin with articulating the perspectives, goals, and appropriate measures for deriving value from data that they want the rest of the organization to follow.

To help senior leaders define their data performance objectives, this paper draws its balanced scorecard inspiration from Pigni et al.'s (Pigni et al., 2016 ) article on generating value from Digital Data Streams. In their review of how firms innovate using digital data streams, Pigni et al. ( 2016 ) described five opportunities for how companies derive value from data along with four “readiness components” needed to create an environment conducive for pursuing those opportunities. The results of their analysis provide a sound basis for the perspectives of a balanced scorecard for guiding organizations on how to derive value from their data assets. Table 2 shows how the perspectives for the balanced data scorecard map to Pigni et al. ( 2016 ) Data Streams Value Framework. These data driven perspectives correlate well with the perspectives of the classic balanced scorecard: Data Monetization to Financial, Data Consumer to Customer, Data Governance to Internal Business, and Data Readiness to Innovation and Learning.

Overview of data scorecard perspectives and their roles in generating data value.

Goals and Measures for Data Monetization (Financial Perspective)

There is widespread consensus that organizations need to achieve financial or competitive gains from their data (Goodwins, 2018 ; Laney, 2018 , p. 28–52; Lonnon, 2018 ; Sakpal, 2019 ; Ahmad, 2020 ; Uttamchandani, 2020 ). For the Data Monetization perspective, senior leaders have several ways for how firms can derive value from their data assets.

• Increase Revenue: Organizations can use data to increase their revenue streams. Examples of this include using data to aid in customer acquisition and retention efforts (Laney, 2018 , p. 29–31; Sakpal, 2019 ; Earley, 2020 ), using data to improve sales or speed of delivery of products and services (Henderson, 2015 ; Laney, 2018 , p. 35–37), developing new lines of business based on innovative usages of data (Laney, 2018 , p. 33–34; Earley, 2020 ), or developing partnerships involving the sale or bartering of data to obtain more favorable terms or exchanges involving goods and services (Laney, 2018 , p. 38–39).
• Increase Market Presence: Organizations can use data to enhance the organization's stature through better corporate citizenship such as sponsoring open data portals or improving one's ranking in industry reports (Ajilitee, 2011 ; Laney, 2018 , p. 45–48). While this may not have a direct impact on the firm's bottom line, it can boost an organization's brand recognition, adding to its social capital.
• Reduce Costs: Organizations can use data to reduce its operating costs (Ajilitee, 2011 ; Henderson, 2015 ; Firican, 2018 ; Laney, 2018 , p. 41–44; Foster, 2019 ; Stedman, 2020 ).
• Improve Performance: Organizations can use data to help improve the performance (e.g., timeliness, quality) of its operations (Henderson, 2015 ; Subramanian, 2017 ; Laney, 2018 , p. 36–37).
• Improve Decision Making: Organizations can use data to enable their decision-makers to make decisions faster (Laney, 2018 , p. 40–41), or with greater confidence (Foster, 2019 ), or with less chance of error (Subramanian, 2017 ).
• Reduce Risk: Organizations can use data to reduce risk such as being able to better spot fraud, security breaches, or privacy issues which improves the bottom line through improved regulatory compliance and avoidance of penalties (Ajilitee, 2011 ; Smith, 2017 ; Subramanian, 2017 ; Laney, 2018 , p. 44–45).

Table 3 summarizes some examples of goals and metrics related to data monetization. Organizations should adjust the emphasis placed on the various options depending on the strategic priorities of the firm.

Data monetization example goals and metrics.

Goals and Measures for Data Consumer (Customer Perspective)

Getting the right data to the organization's constituents who need to work with that data is another priority for organizations to fully realize the value of their data (Dyché J., 2018 ; Sakpal, 2019 ; Ahmad, 2020 ; Uttamchandani, 2020 ). For the Data Consumer perspective, keeping data consumers satisfied requires that the organizations deliver on several significant areas.

• Ensure Data Quality: Making sure that data is fit for use is a widely cited goal among industry practitioners. Organizations need to make sure that their data is valid, consistent, current, and complete for a given data source (Ajilitee, 2011 ; Loshin, 2013 ; Henderson, 2015 ; Dennis, 2017 ; Subramanian, 2017 ; Firican, 2018 ; NYU Langone Health System, 2018 ; Seiner, 2018 ; Foster, 2019 ; Stedman, 2020 ) as well as between related data sources (Ajilitee, 2011 ; Henderson, 2015 ; Dennis, 2017 ; Stedman, 2020 ).
• Build Data Infrastructure: Organizations need to make sure there is an adequate infrastructure in place that allows data consumers to easily find and access the data that they need. Designing an efficient and secure data ecosystem that supplies data where needed is another important performance area for organizations (Ajilitee, 2011 ; Henderson, 2015 ; Dennis, 2017 ; Smith, 2017 ; Firican, 2018 ; Laney, 2018 , p. 80–102; Earley, 2020 ).
• Deliver Data Services: Data consumers in the organization require services such as a data helpdesk so they can get their access requests, questions, and concerns about their data addressed. Key areas for measuring data service quality include the variety of data identified and available to data consumers (Ajilitee, 2011 ; Henderson, 2015 ; Dennis, 2017 ; Seiner, 2018 ; Stedman, 2020 ), as well as the satisfaction of the data consumers with the timeliness, reliability, and completeness of data services provided (Ajilitee, 2011 ; Loshin, 2013 ; Henderson, 2015 ; Dennis, 2017 ; NYU Langone Health System, 2018 ; Stedman, 2020 ).

Table 4 summarizes some examples of goals and metrics related to satisfying data consumers. Organizations should adjust the emphasis placed on the various options depending on the strategic priorities of the firm.

Data consumer example goals and metrics.

Goals and Measures for Data Governance (Internal Business Perspective)

Good data governance is essential to an organization's ability to work with its data. Dennis ( 2017 ) identifies three fundamental areas: people, processes, and technology that must be addressed for effective data governance.

• Engage People: For data governance to be effective, it is important that there is engagement among the different stakeholders. Organizations need to pay attention to the level of interactions between their data governance council and their business process owners, data stewards, IT personnel, and data consumers regarding their awareness of data governance policies and practices, their willingness to provide input to data governance deliberations, and their commitment in following through on desired data behaviors (Ajilitee, 2011 ; Loshin, 2013 ; Henderson, 2015 ; Dennis, 2017 ; Smith, 2017 ; Firican, 2018 ; Seiner, 2018 ; Stedman, 2020 ).
• Get Data Processes Right: Organization need to make certain that data governance processes (including those for generating and enforcing data policies) are streamlined and responsive to the needs of the organization and its employees. Organizations need to monitor the extent to which data policies and processes have been developed and adopted by their personnel (Henderson, 2015 ; Dennis, 2017 ; Smith, 2017 ; Seiner, 2018 ; Stedman, 2020 ). Organizations should also track improvements to data policies and processes that resulted in elimination of duplicate effort, reduction of data errors or failures, or improved regulatory compliance (Ajilitee, 2011 ; Henderson, 2015 ; Dennis, 2017 ; Subramanian, 2017 ; Firican, 2018 ; Seiner, 2018 ; Foster, 2019 ; Stedman, 2020 ).
• Automation of Effort: As the amount of data grows, technology is required to help automate tasks to make it easier and quicker for an organization's data governance efforts to keep up. Organizations should consider metrics that track the reduction in manual effort (Ajilitee, 2011 ; Loshin, 2013 ; Henderson, 2015 ; Dennis, 2017 ; NYU Langone Health System, 2018 ; Stedman, 2020 ) along with metrics that track the time savings (Ajilitee, 2011 ; Loshin, 2013 ; Henderson, 2015 ; Dennis, 2017 ) associated with automation improvements.

Table 5 summarizes some examples of goals and metrics related to delivering effective data governance. Organizations should adjust the emphasis placed on the various options depending on the strategic priorities of the firm.

Data governance example goals and metrics.

Goals and Measures for Data Readiness (Learning and Growth Perspective)

The Data Readiness perspective of the balanced scorecard covers the aspects of the organization's environment that must be in place to encourage and enable employees to find new ways to innovate using data. Employees need to have the skills, tools, and willingness to pursue data analytics (Pigni et al., 2016 ; Sakpal, 2019 ; Ahmad, 2020 ; Uttamchandani, 2020 ). Without these components, organizations may find that they have created a large data engine for their organization without the necessary enablers for employees to make use of that engine (Pigni et al., 2016 ; Bean, 2021 ). In order to facilitate a culture of data literacy, organizations need to work on the following important areas.

• Increased Skills Training: In order to analyze data, employees need to have the prerequisite knowledge and skills. Organizations should periodically assess the level of skills in the organization's employees and to identify areas for improvement (Dennis, 2017 ; Firican, 2018 ; Seiner, 2018 ; Sakpal, 2019 ; Ahmad, 2020 ; Uttamchandani, 2020 ).
• Access to Data Tools: In addition to skills, employees need access to a rich set of tools for querying, wrangling, and analyzing their data (Earley, 2020 ; Uttamchandani, 2020 ).
• Grow an Inquiring Mindset: Finally employees need to be encouraged and rewarded for participating in data initiatives (Ajilitee, 2011 ; Sakpal, 2019 ; Ahmad, 2020 ; Uttamchandani, 2020 ). For organizations, this means using a variety of tactics such as newsletters, bonuses, annual evaluations, and surveys to recognize individuals who are innovating and developing solutions with data.

Table 6 summarizes some examples of goals and metrics related to fostering data readiness. Organizations should adjust the emphasis placed on the various options depending on the strategic priorities of the firm.

Data readiness example goals and metrics.

Implementation Challenges And Closing Thoughts

The balanced data scorecard is a starting point for senior leaders on how they would like their organization to derive value from data. In addition to identifying data monetization objectives, the balanced data scorecard also helps organizations to identify their data consumers' needs, data governance efforts, and the data readiness that must be in place to make it possible for that value to be generated. Figure 2 provides an overview of the main perspectives and goals presented in this paper. Organizations are free to adapt these perspectives and goals to meet their specific circumstances.

Key perspective and goals for the balanced data scorecard.

The master balanced data scorecard generated by senior leadership is the beginning of a long process. The next steps involve the various divisions and departments of the organization generating their own versions of the balanced data scorecard to support the master data scorecard. These scorecards must be shared and vetted to ensure that the collection of balanced data scorecards work together as a whole without creating suboptimal situations where one group's pursuit of their data objectives undermine the overall efforts of other groups in the organization. Once a portfolio of balanced data scorecards has been established then the organization must follow through with a regular cycle of gathering the metrics for each of the performance goals, assessing the current state of data, devising action plans for improvement for the coming cycle, and updating the various balanced data scorecards to keep them relevant to the needs of the firm.

Organizations will need a comprehensive data measurement system to accompany their balanced data scorecard management system. While the balanced data scorecard will answer some questions regarding the business needs that are driving measurement and how those metrics should be defined, Redman ( 2005 ) lists a number of other important questions that must be addressed for successful performance monitoring to occur.

• Where and when should the measurements be taken?
• Who is responsible for producing the metric?
• What measurement device or protocol should be used?
• What data (evidence) to include in the calculation of the metric?
• How should results be summarized and reported?
• How should the measurements be interpreted and used for taking action?

While it would be great if there was a shorter path for organizations to attain the full potential of their data, the hard truth is data is a complicated asset. It is generated, managed, and used throughout the organization. Consequently, data requires the approach of the balanced data scorecard management system to get all parties working together to plan, collect, store, share, and manage data so it can be monetized to create significant value for the organization. More work is needed to study the usefulness of the balanced data scorecard for assisting organizations in improving their bottom lines. At the very least, the balanced data scorecard is a framework for senior leaders to consider when strategizing how their organization can more effectively capitalize upon their data assets.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

This material is based upon work supported by the National Science Foundation under Award No. OIA-1946391.

Conflict of Interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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The Balanced Scorecard—Measures that Drive Performance

• Robert S. Kaplan
• David P. Norton

What you measure is what you get. Senior executives understand that their organization’s measurement system strongly affects the behavior of managers and employees. Executives also understand that traditional financial accounting measures like return-on-investment and earnings-per-share can give misleading signals for continuous improvement and innovation—activities today’s competitive environment demands. The traditional financial performance measures worked well […]

The Idea in Brief

In the same way that you can’t fly an airplane with just one instrument gauge, you can’t manage a company with just one kind of performance measure. Think of a balanced scorecard as the instrument panel in the cockpit of an airplane. It’s a set of interrelated gauges that links seemingly disparate information about a company’s finances and operations. Together, they give you a more complete view of how your company has been performing, as well as where it’s headed.

A balanced scorecard asks you to think of your company’s mission and strategy from four key perspectives:

1. How do customers see us?

2. What internal processes must we excel at?

3. How can we continue to improve and create value?

4. How do we look to shareholders?

Next, identify the handful of measures that are most critical to your company’s success in each of the four perspectives. Tracking all the important measures at once guards against suboptimization—that is, achieving gains in one area at the expense of another.

The Idea in Practice

What you measure is what you get: the measures you use strongly affect the behavior of your managers and employees. When building a balanced scorecard, tailor the measures to fit your company’s particular challenges. That way, you’ll be more likely to get the performance you need to succeed.

1. Customer perspective. Today’s typical corporate mission says something general about customers. The balanced scorecard requires specific measures of what customers get—in terms of time, quality, performance and service, and cost.

2. Internal business perspective. Focus on the core competencies, processes, decisions, and actions that have the greatest impact on customer satisfaction. ECI developed operational measures for submicron technology capability, manufacturing excellence, design productivity, and new product introduction. Company managers then made sure to “decompose” the measures to department and workstation levels, where much of the action took place.

3. Innovation and learning perspective. Measures in this area indicate future success. They measure continual improvements to existing products and processes and introduction of new products with expanded capabilities. Milliken & Co. implemented a “ten-four” improvement program, requiring reductions in key adverse measures (defects, missed deliveries, and scrap) by a factor of ten over four years.

4. Financial perspective. Financial measures are essential for indicating whether executives have correctly identified and constructed their measures in the three foregoing areas—but they can also help determine future direction. For example, a chemical company created a daily financial statement. Putting income and expense values on every production process helped plant supervisors see where process improvements and capital investments could generate the highest returns. Example: 

A semiconductor company that the authors call Electronic Circuits Inc. (ECI) established the goal of becoming customers’ supplier of choice. To track this goal, the company conducted customer surveys, which revealed that each customer had a different definition of what constituted reliable and responsive supply. As a result, ECI discovered that it was not satisfying some customers and overachieving the expectations of others.

What you measure is what you get. Senior executives understand that their organization’s measurement system strongly affects the behavior of managers and employees. Executives also understand that traditional financial accounting measures like return-on-investment and earnings-per-share can give misleading signals for continuous improvement and innovation—activities today’s competitive environment demands. The traditional financial performance measures worked well for the industrial era, but they are out of step with the skills and competencies companies are trying to master today.

• Robert S. Kaplan is a senior fellow and the Marvin Bower Professor of Leadership Development emeritus at Harvard Business School. He coauthored the McKinsey Award–winning HBR article “ Accounting for Climate Change ” (November–December 2021).
• DN David P. Norton is a founder and director of the Palladium Group and is the coauthor of The Balanced Scorecard: Translating Strategy into Action .

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Balanced scorecard: trends, developments, and future directions

• Review Paper
• Open access
• Published: 30 September 2023

You have full access to this open access article

• Satish Kumar 1 , 2 ,
• Weng Marc Lim 3 , 4 ,
• Riya Sureka 5 ,
• Charbel Jose Chiappetta Jabbour 6 &
• Umesh Bamel 7  

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Cite this article

Balanced scorecard (BSC) is widely studied and practiced. As research on the BSC has matured since its introduction in 1992, it is timely to assess its progress and outline future directions. This study synthesizes extant research and presents avenues to advance the BSC. To accomplish these objectives, we undertake a review employing a bibliometric and systematic methodology on a corpus of 1294 BSC-related studies. The review reveals that the more than 30-year history of BSC research has followed a bell-curve trajectory, with publications appearing in high-quality, multidisciplinary journals and contributions from numerous author groups worldwide. Moreover, the review highlights the evolution of major themes and topics on the BSC, encompassing customer orientation, financial management, integrated reporting, strategic performance management, sustainable development, and systems thinking. Sustainability BSC has also gained prominence due to sustainability firmly establishing itself as a global agenda and grand challenge. Taken collectively, this review serves as a one-stop resource for gaining a state-of-the-art understanding of the trends, developments, and future directions of the BSC.

Avoid common mistakes on your manuscript.

1 Introduction

“The balanced scorecard is like a smartphone’s health and fitness app, compiling multiple metrics into a single dashboard; it gives managers a comprehensive view of organizational health and guides strategic action”—The authors.

With the continued development of technology, the globalization of the marketplace, and the evolution of stakeholder expectations, the business environment in which firms operate within has become increasingly disruptive in addition to being volatile and uncertain as well as complex and ambiguous (DVUCA) (Ciasullo and Lim 2022b , 2023 ; Pattnaik et al. 2022 ). Within the DVUCA environment, firms are naturally expected to respond (manage, perform) with agility, purpose, and excellence, thereby accentuating the necessity and importance of strategic performance measurement and management tools that can support firms in meeting this expectation (Lim, Ciasullo et al. 2023 ).

Developed by Robert Samuel Kaplan and David P. Norton who published in the Harvard Business Review , the balanced scorecard (BSC) was introduced and popularized as a strategic tool for performance measurement and management that focuses on

a strategic agenda (i.e., vision, mission),

a mix of strategic objectives (i.e., economic and non-economic),

a set of measurements, and

a portfolio of initiatives designed to meet (i) and (ii).

In this regard, the BSC considers not only

financial performance (i.e., how do shareholders see us?) but also

customer satisfaction (i.e., how do our customers perceive us?),

internal business processes (i.e., what must we do well?), and

innovation and learning (i.e., how can we engage in continuous improvement and value creation?) (Kaplan and Norton 1992 ).

Therefore, the BSC, which essentially lists and connects strategic objectives against performance measures, can be viewed as a strategic management tool that

operationalizes strategy (vision, mission) into more specific and tangible forms for measurement and management,

ensures that key (multidimensional) information, both financial and non-financial, are identified, monitored, and actioned upon,

offers a balanced view of the organization, and

provides a comprehensive yet succinct overview of strategic progress that complements detailed management (financial, operational) reports.

Nonetheless, like any concept, framework, model, taxonomy, or theory, the BSC has been widely debated, resulting in the advancement of its theoretical foundation and managerial practice.

From a theoretical standpoint, the BSC, in its initial years, was criticized for the lack of empirical evidence and rigor supporting its establishment as a management tool (Norreklit 2000 ). This has led to a plethora of empirical research, both from Kaplan and Norton as well as other scholars, as noted by an earlier review (Hoque 2014 ) as well as our present review of the BSC. Substantial enhancements in the theoretical exposition of the BSC have since been made. One such enhancement is the articulation of the links between strategic objectives that play a pertinent and profound role in the strategic linkage model or the strategy map, which is a distinction of the second-generation BSC (Kaplan and Norton 1996a ). This feature amplifies the understanding of how strategic objectives drive performance, leading to a more contextually justifiable selection of measures and initiatives. Furthermore, the introduction of the ‘destination statement’ in the third-generation BSC provides a clearer picture of what strategic success resembles (Lawrie and Cobbold 2004 ). This clear vision empowers managers to intervene proactively to correct any divergence or enhance current undertakings as opportunities emerge.

From a practical viewpoint, critics lamented the commercial focus (customers, shareholders) of the BSC, rendering the strategic performance measurement and management tool less relevant for public and non-profit organizations, where elements such as non-commercial stakeholders (e.g., society) and the distinctive nature of collaboration (as opposed to competition) are regarded as important considerations for strategic performance measurement and management (Kong 2010 ). This has led to a plethora of endeavors to adapt or contextualize the BSC, for example, the public sector scorecard (Moulin 2017 ) and the results-based management method (Lawrie et al. 2005 ), which take into account the interests of a wider and more diverse group of stakeholders (e.g., local communities, supply chain partners), going beyond customers and shareholders, in line with stakeholder theory (Mahajan et al. 2023 ). Besides the extrapolation of the BSC beyond commercial settings, another noteworthy practical advancement is automation through the use of technology (software) to support managers in developing, updating, and reporting the BSC (Marr and Neely 2003 ), thereby showing that the complexity of the BSC, especially when they are extrapolated across business units and departments (i.e., multiple BSCs), can be pragmatically managed with ease by leveraging the advances and benefits of technology.

With the advancement of the BSC, several noteworthy trends are observed. At its peak, the BSC was reportedly used by 53% of companies in the late 2000s (Rigby and Bilodeau 2009 ), though its use has plummeted to 29% in the late 2010s (Rigby and Bilodeau 2018 ) based on the responses of more than 1,000 managers of global companies surveyed by Bain and Company. However, in the early 2020s, 2 GC ( 2021 ) reported that the usage of BSC has increased at the executive level from 44% in 2019 to 88% in 2020, and that 80% of the private and public sector organizations surveyed across 21 countries have found the BSC as or more useful than before the COVID-19 pandemic, and thus, reaffirming the value of the BSC as a strategic performance measurement and management tool that supports organizations in managing and responding to strategic change.

Building upon the existing body of BSC research, which has broadened and evolved over time, this study extends beyond previous reviews. Hoque ( 2014 ) conducted a 20-years systematic literature review (SLR) of 114 BSC articles from 25 accounting and 67 business and management journals, which highlighted the various topics, settings, theories, methodologies, and analytical techniques within the field. However, our study does not restrict its scope to solely accounting and management, instead encompassing all aspects of BSC. Furthermore, in contrast to prior work, our study adopts an SLR approach using a bibliometric analysis with a temporal perspective. This approach presents an exhaustive overview of the field, revealing the intellectual structure of the field alongside its evolution over time (Carlsson et al. 2017 ; Xu et al. 2018 ). In this regard, this study seeks not only to extend Hoque ( 2014 )’s work but also to uncover new insights into the progress and diversification of BSC research across various timelines. Discerning the thematic structure of BSC is crucial for both academic and practical applications, assisting in the understanding of BSC trends and its application in contemporary performance measurement practices amidst complex stakeholder interactions. In addition, this study will also suggest potential avenues for future research, contributing to the advancement of the BSC field.

In the decade since the last review, there has been a marked opportunity for a timely update on the field’s progression (Lim et al. 2022a , b ). Tawse and Tabesh ( 2022 ) recently conducted a 30-year review of 11 BSC articles that contained statistical data, which allowed them to calculate the effect size of the relationships between BSC usage and firm performance. This offered corroborative evidence indicating the positive contributions of BSC to organizational outcomes. However, as the current study demonstrates, the body of BSC research is vast (> 1000 articles), suggesting previous reviews (Hoque 2014 ; Tawse and Tabesh 2022 ) have offered limited coverage (Table 1 ). Furthermore, the performance of BSC research in terms of publication and citation has yet to be rigorously analyzed, a critical step in establishing the field’s productivity and impact (Donthu et al. 2021 ). Also, the scientific knowledge of BSC research has yet to be holistically mapped, which is crucial for establishing the intellectual structure of the major themes and topics in the field (Mukherjee et al. 2022 ). In employing a bibliometric analysis, this study offers an efficient, bias-minimized approach capable of objectively analyzing a vast corpus of articles. As an established review method, bibliometric analysis has proven itself a potent tool for effectively handling, reviewing, and examining substantial scientific data (Donthu et al. 2021 ). Using this approach, our study offers a highly comprehensive and objective overview of BSC research, focusing on the field’s productivity, impact, and thematic scope. In this regard, our study serves as an essential reference point, providing an updated, comprehensive overview of BSC research’s current state and future prospects. Thus, our study facilitates the understanding of current trends, developments, and future directions, and should be useful for academics, practitioners, and students interested in the evolution and impact of BSC.

2 Methodology

This study adopts an SLR approach to review the extant literature on the BSC. An SLR involves the systematic search (i.e., corpus curation) and evaluation (i.e., corpus analysis) of relevant studies in the body of knowledge (Bouncken et al. 2015 ; Sauer and Seuring 2023 ; Tranfield et al. 2003 ; Vlačić et al. 2021 ). The evaluation part of an SLR could be performed in numerous ways, most notably through a bibliometric analysis (automated) or a content analysis (manual) (Kraus et al. 2022 ). Given the large corpus of studies on the BSC, it would be more pragmatic and sensible to engage in the former rather than the latter (Donthu et al. 2021 ).

2.1 Corpus curation

Differing from a traditional review, an SLR follows a structured process that can be transparently disclosed and replicated, thereby mitigating review ambiguity and bias (Lim et al. 2022a , b ; Rowley and Slack 2004 ; Sauer and Seuring 2023 ; Tranfield et al. 2003 ). Three databases are commonly used in review studies: Google Scholar, Scopus, and Web of Science (WoS) (Kraus et al. 2022 ). However, Google Scholar is not utilized for bibliometric reviews as it does not offer essential bibliometric data for download (Donthu et al. 2021 ). Between Scopus and WoS, Scopus is the larger database, offering a wider coverage of peer-reviewed literature (Norris and Oppenheim 2007 ; Sharma et al. 2023 ). Roughly 95% of the journals indexed in WoS are also indexed in Scopus, while only about half of the articles indexed in Scopus are also indexed in Web of Science (Mongeon and Paul-Hus 2016 ). This demonstrates the broader reach of Scopus as compared to WoS. Thus, to curate a corpus of relevant articles for review, this study carried out a Scopus ( search engine ) search for “English” (language) “article” and “review” documents ( document type ) on “balanced scorecard” ( search keyword ) in the “article title, abstract, and keywords” ( search field ) up to July 2023 ( search period ). This search criteria can be justified on the basis that (i) Scopus is a scientific database that indexes one of the largest collection of articles for sources that have passed stringent quality standards (and more than the Web of Science), (ii) English is the only language that all authors of this article are most proficient in, (iii) article and review documents typically undergo full-fledge peer review unlike other document types such as editorial and notes, (iv) the use of a single keyword is sufficient when that keyword is central and plays a non-negotiable part to the study, (v) keywords that appear in the article title, abstract, and keywords sections of a document are likely to be central to that document, and (vi) the start of the search period was left undefined but the end of the search period was naturally limited to the time of search to capture the maximum number of relevant documents available at the time of study. The search based on these criteria and justifications, which are in line with recent reviews (e.g., Lim et al. 2021 , 2022a , b ) and review guides (Kraus et al. 2022 ), returned a total of 2,957 documents.

Given that potential concerns of predatory publishing have been raised by recent scholars such as Marina and Sterligov ( 2021 ) despite Scopus’s stringent indexing criteria and corrective actions to remove predatory sources from their list, this study took additional precaution by subjecting the 3,344 documents to quality filtering, ensuring that only documents published in high-quality and legitimate outlets are included for review. To do so, the research incorporated documents that were assessed by at least two of the following sources: the Chartered Association of Business Schools Academic Journal Guide (ABS), the Australian Business Deans Council Journal Quality List (ABDC), or the Web of Science Impact Factor (WoS IF). Following this form of quality filtering, the final set of documents consists of 1,294 documents, which we reviewed using the methods described in the next section.

2.2 Corpus analysis

There are many methods to perform an SLR (e.g., content analysis, bibliometric analysis, meta-analysis) (Lim et al. 2022a , b ). In this study, the bibliometric approach was adopted to review extant BSC research, as it leverages technological automation, enabling analysis of a large corpus of documents while maintaining objectivity through quantitative and statistical methods (Donthu et al. 2021 ). Bibliometrics was a term coined by Pritchard ( 1969 ) to refer to the bibliographic aspects of scientific documents (e.g., author information, article information) that can be analyzed using various quantitative methods or statistical tools to construct an objective understanding (Zupic and Čater 2015 ) and provide meaningful inferences about various facets of the literature (Carlsson et al. 2017 ). By convention, an SLR powered by bibliometric analysis involves the implementation of performance analysis and science mapping (Donthu et al. 2021 ). In particular, the productivity and impact of the literature is assessed based on publications and citations as part of the performance analysis, whereas the major author groups, themes, and topics in the literature are discovered and mapped as part of science mapping, thereby providing an objective assessment of the field’s performance as well as an objective understanding of the nomological network of knowledge in that field (Mukherjee et al. 2022 ).

In this study, a performance analysis is carried out to ascertain (i) the publication (productivity) trend of BSC research, (ii) the top journals (productively) contributing to BSC research, and (iii) the most influential (global citation) and prestigious (local citations by highly cited articles) BSC publications. In addition, a science mapping is conducted to establish (i) the major author groups and country collaborations (using co-authorship analysis) and (ii) the major themes and topics (using a co-occurrence analysis of keywords) of BSC research. The performance analysis is executed via the Microsoft Excel software while the science mapping (co-authorship analysis, co-occurrence analysis of keywords) is implemented using the Gephi software (Bastian et al. 2009 ). The use of multiple software, where appropriate (useful), is also aligned with Donthu et al. ( 2021 ). Figure  1 presents a summary of the review procedure of corpus curation and corpus analysis.

Review procedure. Note A comprehensive search was conducted using Scopus, a widely recognized academic database, to retrieve relevant literature on the topic of “balanced scorecard”. The Scopus search yielded a total of 1,294 documents, providing a robust dataset for analysis. This approach was chosen due to its extensive coverage and reputation for indexing a diverse range of scholarly sources. It is worth noting that an alternative search on the Web of Science database using the same keyword initially retrieved 1,824 documents. However, after applying filters for English language, document type (articles and reviews), and considering quality criteria such as the Chartered Association of Business Schools Academic Journal Guide (ABS), the Australian Business Deans Council Journal Quality List (ABDC), or the Web of Science Impact Factor (WoS IF), the results were further refined to a total of 765 documents. Given the larger number of documents retrieved from Scopus, it was deemed more suitable for this study’s purposes. In this regard, using Scopus as the primary database ensures a comprehensive and diverse selection of scholarly articles, enhancing the reliability and validity of the findings

3 Performance analysis of BSC research

3.1 publication trend of bsc research.

Since its inception in 1992 (Kaplan and Norton 1992 ), numerous scholars have contributed to BSC research till 2023. In particular, 1294 publications on the BSC have appeared in journals rated or ranked in at least two out of the ABS, the ABDC, or the WoS IF (Fig.  2 ).

Publication trend of BSC research

The productivity (publication) of BSC research has generally been on an upward trajectory over two decades (1992–2012) (Fig.  2 ), which may be attributed to the pipeline of scholarly contributions by Kaplan and Norton during this period. This pipeline includes demonstrating the application of the BSC (Kaplan and Norton 1993 ), the linkage of the BSC to strategy (Kaplan and Norton 1996a ), the utility of the BSC as a strategic management system (Kaplan and Norton 1996b ), the translation of strategy into action using the BSC (Kaplan and Norton 1996c ), the utility of strategy maps in the BSC for converting intangible assets into tangible outcomes (Kaplan and Norton 2004 ), the techniques for mastering the BSC (Kaplan and Norton 2008a ), the execution premium of competitive advantage for linking strategy to operations using the BSC (Kaplan and Norton 2008b ), and the management of alliances with the BSC (Kaplan et al. 2010 ).

However, the productivity of research on the BSC has shown a decline and downward trend since its inception in 1992, particularly in the third decade (2012–2023) (Fig.  2 ). While this decline could be attributed to the retirement of the founders of the BSC, it is evident that the current situation underscores the importance of additional scientific research to progress the field. Interestingly, 2023 marks a resurgence in BSC research, likely driven by the global emphasis on sustainable development goals in the wake of COVID-19 (Lim 2022a ). Researchers are now recognizing the urgency to evolve the BSC framework by integrating contemporary business trends like ESG metrics and addressing obstacles to its effective deployment (Lim, Ciasullo et al. 2023 ). The proposed future research directions outlined in this study aim to assist scholars in bolstering BSC research in the coming years. Therefore, it is evident that novel ideas are required to rejuvenate the BSC and propel its research towards a positive growth trajectory.

3.2 Top journals contributing to BSC research

The 1294 publications on the BSC over three decades Footnote 1 (1992–2023) have appeared in 340 journals rated or ranked in either the ABS, the ABDC, or the WoS IF (Table 2 ). The top three most productive journals for BSC research are International Journal of Productivity and Performance Management (TP: 74), Measuring Business Excellence (TP: 52), and Expert Systems with Applications (TP: 31), all of which represent outlets with a focus on achieving business excellence through strategic performance measurement and management. Nonetheless, the relevance of the BSC is also witnessed across numerous application or specialty areas, including accounting (e.g., Managerial Auditing Journal ), healthcare (e.g., International Journal of Health Care Quality Assurance ), information systems (e.g., International Journal of Business Information Systems ), knowledge management (e.g., Journal of Knowledge Management ), and sustainability (e.g., Journal of Cleaner Production ). This shows that the BSC has utility for advancing both mainstream strategic management as well as application or specialty areas across contexts. However, existing research on the BSC primarily appears in journals that predominantly focus on accounting and operations research, emphasizing the limited integration of the BSC in other management domains such as marketing and innovation. This highlights the strain and underscores the importance of incorporating the BSC in diverse management fields. Thus, there is a clear opportunity for scholars to explore the application of the BSC in different areas of management and contribute to the development of the next-generation frontiers of research in this field. Additionally, publishing in premier journals serves as a signal that should motivate scholars to invest their valuable time and effort in exploring new avenues that can enhance both the theory and practice of the BSC.

3.3 Most influential BSC research

The research on the BSC that holds the most influence is determined through the examination of global citations, which includes citations received from both BSC and non-BSC research (Ding and Cronin 2011 ). Identifying influential articles is crucial for gaining insight into the intellectual dynamics of the research field (Donthu et al. 2021 ). The findings of this analysis can be particularly useful for scholars in the BSC field, as it enables them to navigate and prioritize the most important works (Table 3 ). The most influential BSC research is Kaplan and Norton ( 1992 ) (TC: 7700), which introduces the BSC as a strategic performance measurement and management tool. This observation is unsurprising given the seminal status of this publication in establishing the BSC. The other two publications listed in the top three most influential BSC research are Jensen ( 2002 ) (TC: 1170), which criticizes the BSC for not providing managers with a score to indicate how they have performed, and Otley ( 1999 ) (TC: 939), which showcases the complementary value of the BSC with budgeting and economic value added in a trifecta system of organizational control. Other works by Kaplan and Norton ( 1996a , b , c , 2000, 2004 ) also appear in this list alongside other prominent scholars such as Andy Neely (e.g., Neely 2005 ; Neely et al. 2000a , b ) and Christopher D. Ittner (e.g., Ittner et al. 2003a , b ; Ittner et al. 2003a , b ) who have contributed both conceptual and empirical works on the BSC. This shows that the BSC has its fair share of advocates and critics, which bodes well for academic freedom, scholarly debate, and knowledge advancement. More importantly, prospective authors should be cognizant of these high-impact BSC research and use them, where appropriate, to build a strong theoretical foundation and positioning for advancing the BSC in their future research.

3.4 Most prestigious BSC research

It is essential not only to examine influential articles but also to explore prestigious articles in order to understand the intellectual milestones of the field (Kumar et al. 2022a , b ). The most prestigious BSC research is often determined using PageRank (Donthu et al. 2021 ). Unlike citations, which basically measures the number of times a document is cited, PageRank calculates the prominence of a document within a collection of documents by computing a score based on the number of citations a paper receives from other highly cited papers in the field (Brin and Page 1998 ). When applied to this study, PageRank accounts for the local citations received by a BSC research paper from highly-cited BSC research papers (Table 4 ). In this regard, PageRank serves as an indicator of both popularity and prestige (Donthu et al. 2021 ). The most prestigious BSC research are Bartlett et al. ( 2014 ) (PageRank: 0.0043), which sheds light on how the inclusion of a strategy implementation timeline and varying levels of accountability affect the emphasis that evaluators, in roles of either supervisors or subordinates, place on leading non-financial versus lagging financial measures in a BSC, and Malagueño et al. ( 2018 ) (PageRank: 0.0043), which reveals that the use of the BSC positively impacts financial performance and exploitative innovation, particularly in more established firms. This indicates that BSC research that may not necessarily be highly cited due to various reasons (e.g., article age, content niche or specialty) can still yield a significant impact on the field by influencing the foundational knowledge relied upon by highly-cited BSC research. In that sense, prospective authors are highly encouraged to be well verse with not only the most influential BSC research but also the most prestigious BSC research as they are very likely to be both useful and relevant for establishing a strong theoretical foundation for new BSC research.

4 Science mapping of BSC research

4.1 co-authorship (collaboration) network of bsc research.

The most prolific authors for BSC research are Robert S. Kaplan (TP: 16), David P. Norton (TP: 13), Wayne G. Bremser (TP: 11), and Mike Bourne (TP: 9). To provide a deeper dive on the main author groups for BSC research, a co-authorship analysis was conducted. Footnote 2 According to Acedo et al. ( 2006 ), co-authorship in a scientific domain signifies official partnerships. The collaborative network of author interactions was visualized using the Gephi software (Bastian et al. 2009 ). Initially, a.net file was created from a.csv file containing bibliographic data from 1294 documents. The resulting file was then processed in the Gephi software, where the Louvian algorithm, which identifies communities within a large network by optimizing the modularity index (Blondel et al. 2008 ), was employed to establish co-authorship networks and groups. A summary of the most collaborative author groups, their geographical affiliations, and research focuses is presented in Table 5 . The table also highlights the three main academic outlets where these author groups frequently publish. The analysis revealed eight major author groups specializing in BSC research. Readers can utilize this information to identify experts for consultation and collaboration based on geographical location and/or research focus areas related to the BSC.

Author Group 1 , one of the joint largest author groups, is led by José Baltazar Salgueirinho Osório de Andrade Guerra, with a total link strength of 23. This group includes other notable authors such as Samara da Silva Neiva, Wellyngton Silva de Amorim, André Borchardt Deggau, and Samuel Borges Barbosa. While these authors are based in Brazil and the United Kingdom, their research extends beyond their geographical affiliations. The research of this group, which is most recent (APY: 2020.00–2021.00), focuses on the intersection of the BSC with food stability, environmental education, sustainable development goals, and strategic management. Their work has been published in esteemed outlets, including the Journal of Cleaner Production , Sustainable Development , and the Stochastic Environmental Research and Risk Assessment . Notable works by this author group include publications by Da Silva Neiva et al. ( 2021 ) and Ribeiro et al. ( 2021 ).

Author Group 2 , one of the joint largest author groups, is led by Wayne G. Bremser, whose total link strength is 12. Other notable authors in this group include Hemantha S.B. Herath, Jacob G. Birnberg, and Lasse Mertins. These authors are affiliated with institutions in Canada and the United States. The research conducted by this group, which falls within a moderately recent time frame (APY: 2007.00–2020.00), primarily focuses on the BSC in conjunction with open reporting systems (or collaborative BSC), performance measurement, and research and development. Works contributed by this group include Herath et al. ( 2014 , 2019 ) and Bremser and White ( 2000 ). Their research has appeared in international journals like Accounting Research Journal , Advances in Management Accounting , and the Journal of Accounting Education .

Author Group 3 is headed by Luis E. Quezada with a total link strength of 13, followed by Pedro I. Palominos. This group, which is based in Chile and Colombia, focuses on business strategy and strategy maps. Also, the group shows an inclination towards analytic network process (ANP) and decision-making trial and evaluation laboratory (DEMATEL) methodologies (Quezada et al. 2014 , 2022 ). The research conducted by this group are published in premier outlets like International Journal of Production Economics and Management Decision.

Author Group 4 , led by Andy Neely with a total link strength of 17, comprises notable authors such as Mike Bourne and Bernard Marr. These authors are based in the United Kingdom. The group’s research, conducted around 2003.25 and 2005.00, primarily focuses on the automation of the BSC and the design of performance measurement and management systems that utilize the BSC (Neely et al. 2000a , b ; Marr et al. 2004 ).

Author Group 5 , led by John Sands with a total link strength of 7, consists of notable authors such as Errol R. Iselin and Lokman Mia, who are located in Australia. This group’s research, conducted around 2009.25 and 2011.20, primarily focuses on the BSC in conjunction with continuous improvement systems, environmental performance, goal setting, performance reporting, and reporting systems. Noteworthy works by this trio include Iselin et al. ( 2010 ) and Iselin et al. ( 2008 ), which explore the multi-perspectives of performance measurement, systems, and reporting.

Author Group 6 , led by V. Kumar with a total link strength of 7, features other notable authors such as Diego Galar, Aditya Parida, and Christer Stenström, located in Canada, India, and Sweden. Their research, conducted around 2008.75 and 2014.67, mainly encompasses conceptual and review studies on the BSC in connection with e-business success and maintenance performance management. This group has contributed primarily to review and conceptual works such as Kumar et al. ( 2013 ) and Frederico ( 2021 ).

Author Group 7 , comprising Ali Anjomshoae, Adnan Hassan, and Kuan Yew Wong, has a total link strength of six and is based in Malaysia. Their research, published around 2019, primarily revolves around the BSC in conjunction with the humanitarian context. Their main areas of expertise lie in humanitarian relief organizations’ performance management and humanitarian supply chains (Anjomshoae et al. 2017 , 2019 ).

Author Group 8 , led by Amy H. I. Lee with a total link strength of 6, includes notable authors like Hsing Hung Chen and Yunhuan Tong. These authors are located in China and Taiwan. The group’s research, conducted around 2008.00, predominantly explores the integration of the BSC with knowledge management, new product development, and process development management (Chang et al. 2013 ). The scholars also demonstrate expertise in employing multi-criteria decision-making techniques such as fuzzy analytic hierarchy process and analytical network process (Lee et al. 2008 ).

Author Group 9 consists of Chin-Tsai Lin, Pei-Hsuan Tsai, and Cheng-Ru Wu, each with a total link strength of six. These authors are based in Taiwan. The group’s research, conducted around 2010.00, primarily investigates the application of the BSC in the financial services sector, specifically in the context of performance management and wealth management banks. Their works address various issues related to wealth management banks, including business performance, financial services, and performance measurement models utilizing the BSC approach (Wu et al. 2010 ).

4.2 Country (collaboration) network of BSC research

The most prolific countries for BSC research are the United States (TP: 198), the United Kingdom (TP: 174), Australia (TP: 102), Taiwan (TP: 73), Italy (TP: 63), Canada (TP: 54), Spain (TP: 53) and Iran (TP: 50). The country (collaboration) network for BSC research is depicted in Fig.  3 using a network analysis. The figure indicates that the United Kingdom is the most prominent lynchpin with the highest collaborations, followed by the United States. The country (collaboration) network involving these two countries are fairly large and wide, unlike countries such as Chile, Colombia, and Switzerland, which have a fairly small and narrow network. Other countries that have no or fewer collaborative links with other countries indicate opportunities for cross-country collaborations for future BSC research.

Co-authorship network of countries in BSC research

4.3 Major themes and topics of BSC research

Each keyword that an author lists for their publication reflects the topic that they concentrate on in that publication (Lim 2023 ; Lim and Kumar 2023 ). In that sense, a collection of keywords that frequently appear together would reflect a common theme (Lim 2023 ; Zou et al. 2018 ). This is the fundamental premise of a co-occurrence analysis by means of keyword co-occurrences, which is a technique frequently used for science mapping in bibliometric analysis (Donthu et al. 2021 ; Lim 2023 ; Kumar et al. 2021 ). By engaging in a co-occurrence analysis of keywords, the nomological network of the field can be revealed (Mukherjee et al. 2022 ), making it possible to identify extant gaps, which can be used as a premise for recommending directions for future research (Castriotta et al. 2019 ). The temporal lens can also be applied together with a co-occurrence analysis of keywords to aid in sensemaking (Lim and Kumar 2023 ), thereby providing finer-grained insights on the evolution of major themes and topics in the field (Mukherjee et al. 2022 ).

In this study, the corpus of BSC research is divided into three distinct periods: 1992–2001, 2002–2011, and 2012–2023. This division provides a reasonable time frame for examining the temporal shifts in BSC research over time. To facilitate analysis, a separate file in CSV format containing bibliographic information was created for each time period. Subsequently, each file was individually analyzed in the Gephi software, a network analysis and visualization software, to extract clusters using the modularity function (Bastian et al. 2009 ). The goal of engaging in this analytical endeavor was to gain insights into and map the temporal evolution of themes within BSC research.

The co-occurrence analysis of keywords indicates that the keyword “balanced scorecard” has 653 occurrences (OC), which is unsurprising given its centrality to BSC research. Other notable topics that have been studied in BSC research include “performance measurement” (OC: 131), “performance management (OC: 96)”, “performance measures” (OC: 67), “performance evaluation” (OC: 50), “strategic management” (OC: 42), “organizational performance” (OC: 31), “supply chain management” (OC: 25), “intellectual capital” (OC: 24), “strategic planning” (OC: 24), and “sustainability” (OC: 20). To obtain greater clarity and in-depth understanding of these major topics and their contributions to the major themes in BSC research, the next sections shed light on the development of major themes and topics for BSC research over three decades since its inception. This temporal evolution is also summarized in Table 6 and Fig.  7 .

4.3.1 Period 1 (1992–2001)

The initial decade of BSC research is characterized by three major themes: performance management (purple cluster), knowledge management (orange cluster), and strategic planning (dark green cluster).

The most prominent theme in this decade is performance management (purple cluster). The keyword co-occurrences for this theme indicate that BSC, which is a “strategic management” tool for “performance measurement”, “performance evaluation”, and “performance management”, has been studied in tandem with “corporate governance”, “performance measures”, and “organizational performance”, including in the cases or situations involving “facilities management” and “local government”.

The next major theme in this period is knowledge management . The keyword co-occurrences for this theme suggest that BSC is a useful tool for facilitating the “measurement”, “management”, and “maintenance” of the “performance” and “strategy” of “knowledge management”.

The last noteworthy theme in timeframe is strategic planning . The keyword co-occurrences for this theme signal that BSC is a useful tool for “strategic planning” and provides a profound mechanism for managers to perform a “swot analysis”, going beyond financial agenda and including non-financial agenda such as “quality function deployment”, which accentuates the importance of listening and responding to customer voices.

In understanding the emergence and persistence of these themes during 1992 to 2001, one must consider the broader business and economic context of the era. The late twentieth century witnessed the rise of globalization and the nascent stages of the digital revolution (Autio et al. 2021 ). Consequently, businesses found themselves navigating an increasingly complex environment, necessitating refined tools for performance measurement and strategic direction. The prominence of performance management during this decade can be understood in light of these shifts. Companies needed to ensure not only profitability but also efficacy in their operations, making tools like the BSC vital for assessing both their financial and non-financial performance parameters.

Furthermore, the 1990s marked a period of heightened focus on information and its strategic importance (Donthu et al. 2023 ), leading to the emphasis on knowledge management . Organizations began recognizing that their competitive edge was not solely derived from tangible assets but also from their ability to manage, harness, and capitalize on organizational knowledge. The BSC, serving as a barometer of organizational performance, naturally found its place in assessing how knowledge assets influenced business outcomes.

Lastly, the emphasis on strategic planning can be tied back to the intense competition of the 90 s (Bettis and Hitt 1995 ). With markets expanding and businesses crossing borders, a structured approach to envisioning the future became imperative. BSC’s utility in strategic planning, especially its ability to integrate non-financial parameters like ‘quality function deployment’ and emphasizing customer-centricity, catered perfectly to the era’s demand. Managers needed holistic frameworks to anticipate challenges and opportunities in a rapidly evolving marketplace, explaining the integration of BSC into strategic planning processes during this decade.

4.3.2 Period 2 (2002–2011)

The second decade of BSC research is characterized by six major themes: strategic performance management (pink cluster), customer orientation (black cluster), financial and human resource management (light green cluster), corporate governance (orange cluster), financial reporting (light blue cluster), and knowledge management (dark pink cluster).

The most prominent theme in this decade is strategic performance management (pink cluster). This theme is a combination of the performance management and strategic planning themes in the initial decade between 1992 and 2001, showing the maturity of research in this space, which is reaffirmed by the massive expansion of topics under this consolidated theme. The topics in this theme revolve around aspirations (e.g., “business excellence”, “innovation”, “quality improvement”, “sustainability”), functions (e.g., “crm”, “e-commerce”, “IT”, “research and development”), resources (e.g., “computer software”, “intellectual capital”), strategies (e.g., “business strategy”, “competitive strategy”, “corporate strategy”, “management strategy”, “strategy maps”, “strategy implementation”), “ strategic management ” (e.g., “critical success factors”, “decision making”, “organizational change”, “strategic change”, “strategic planning”), “ performance management systems ” (e.g., “continuous improvement”, “control systems”, “data envelopment analysis”, “knowledge management”, “management accounting”, “management control”, “operations management”, “performance appraisal”, “process management”, “quality management”, “strategic information systems”, “supply chain management”, “total quality management”), and “performance measurement” (e.g., “business performance”, “international standards”, “financial measures”, “financial performance”, “non-financial performance measures”, “organizational performance”, “performance evaluation”, “performance indicators”, “performance levels”) across contexts (e.g., “construction industry”, “food industry”, “health services sector”, “higher education”, “hospitals”, “hotels”, “national health service”, “police”, “public sector organizations”, “SMEs”, “value chain”). Notably, the merging of performance management and strategic planning into strategic performance management can be attributed to several factors. First, the evolving business landscape necessitated a more integrated approach, where strategy and performance are not viewed in isolation but as intertwined facets of successful business operations. Second, advancements in management theory and practices highlighted the synergies between strategic planning and performance metrics, emphasizing their mutual reinforcement. Third, the rise of data-driven decision-making has underscored the importance of aligning strategic objectives with quantifiable outcomes, thus pushing these themes to converge.

The ensuing major theme in this duration is customer orientation (black cluster). This is a new theme that represents the focus on customer orientation in the BSC. This is seen in the BSC’s engagement with “quality function deployment” in achieving “strategic objectives” by transforming customer requirements into product and production planning and development, including in “electronic commerce”, with the insights derived from “r and d management” and “swot analysis” as part of “project management” and “risk management”.

The following noteworthy theme in this era is financial and human resource management (light green cluster). This is a new theme that explores the utility of the BSC in finance (e.g., “banking”, “wealth management”) and human resource (e.g., “communication technologies”, “human capital”, “organizational culture”). The emergence of “sustainability balanced scorecard” in this theme is also noteworthy, signaling the importance of sustainability in economic and non-economic aspects of performance management.

The next primary theme in this interval is corporate governance (orange cluster). This is also a new theme that highlights the importance of “corporate governance” (e.g., “activity-based costing”, “board of directors”) and the value of the BSC (including its extrapolation in the form of the “responsive business scorecard”) as a “benchmarking” tool to safeguard “corporate sustainability”.

This period also showed some niche extrapolations—they relate to financial reporting (light blue cluster) and knowledge management (dark pink cluster), respectively. The former is a new theme that concentrates on “reporting” from the “accounting” perspective and leverages “analytic network process (anp)”, whereas the latter is a recurring theme that focuses on “organizational learning” from the “institutional theory” perspective.

Several factors may account for the emergence and persistence of these themes from 2002 to 2011. The early 2000s experienced an unprecedented surge in technological advancements and globalization, leading to an increased emphasis on customer orientation as businesses sought to differentiate themselves in a rapidly expanding market (Lim, Kumar et al. 2023a , b ). The need to understand and cater to the customer’s unique preferences and greater exposure to information, especially in the age of electronic commerce, made it essential to embed customer orientation in strategic decision-making tools like the BSC.

Additionally, the 2007–2008 global financial crisis underscored the necessity of robust financial and human resource management . Organizations realized the need to integrate financial metrics with human capital indicators in their performance evaluation systems, giving rise to themes that amalgamated financial and HR perspectives in the BSC. This era also witnessed increasing scrutiny around corporate governance practices, in light of major corporate scandals and failures (Cuenca et al. 2022 ; Zaidi and Jamshed 2023 ). Consequently, tools like the BSC became pivotal in reinforcing good governance practices and ensuring corporate sustainability.

Lastly, the nascent information age led to the acknowledgment of knowledge as a pivotal asset (Chopra et al. 2021 ; Donthu et al. 2023 ). Hence, knowledge management , supported by growing digital databases and communication technologies, found its place as a recurring theme. Simultaneously, with the rise of complex business ecosystems, there was a growing need for transparent financial reporting , making it another key focus area during this period.

4.3.3 Period 3 (2012–2023)

The most recent works on BSC research is characterized by seven major themes: strategic performance management (pink cluster), integrated reporting (black cluster), sustainability balanced scorecard (light green cluster), sustainable development (orange cluster), systems thinking (light blue cluster), customer orientation (dark pink cluster), and financial management (dark green cluster).

The most dominant theme in this era is strategic performance management (pink cluster), which is a recurring theme from the last two decades (1992–2011). The scope of topics studied remain relatively similar with the previous decade (2002–2011), with the exception of growing interests around sustainability (e.g., “corporate social responsibility”, “environmental performance”, “environmental sustainability”, “humanitarian logistics”, “impact assessment”, “sustainability reporting”, “triple bottom line”) and technology (e.g., “technology adoption), as well as new methods (e.g., “interpretive structural modeling”, “mcdm”), philosophies (e.g., “pragmatic constructivism”), and theories (e.g., “actor network theory”, “innovation diffusion theory”) being explored more prominently.

This decade of BSE research also marks important contribution on integrated reporting (black cluster), which represents a larger theme emerging out of the niche theme, financial reporting , in the previous decade (2002–2011). The keyword co-occurrences for this theme show that “integrated performance management” leverages on “business intelligence”, “management accounting”, “management accounting innovation”, and “strategic management accounting” for “strategic performance measurement”, resulting in “competitive advantage” and “organizational effectiveness”.

Sustainability balanced scorecard (light green cluster) also appeared as a major theme in this period. This theme reflects an important development in BSC research, wherein the BSC is infused with a sustainability focus in response to the growing sustainability issues in today’s world. The keyword co-occurrences show that “sustainability balanced scorecard” offers an “integrative view” that safeguards “corporate sustainability”, taking into account “corporate social responsibility (csr)” and “environmental accounting” into “decision making” across contexts (e.g., “hospitality”, “hotel performance”). Among the noteworthy methods leveraged for this theme during this decade include “fuzzy linguistic approach” and “soft systems methodology”.

The next noteworthy theme in this interval is sustainable development (orange cluster). This theme reaffirms the third BSC research theme on the responsiveness of BSC research toward addressing the growing sustainability issues that the world is facing today. The keyword co-occurrences for this theme show that the BSC facilitates “strategic alignment” between “business strategy” and “sustainable development”, addressing issues such as “climate change”, “food security”, “health service”, and more broadly, “sustainable development goals”.

The recent BSE research in this period also focuses on systems thinking , which is highlighted in (light blue cluster). This is a new theme that highlights the importance of “systems thinking” in the “management cockpit” of “strategic performance management”. That is to say, a holistic and interconnected perspective is needed for “strategy implementation”, which may involve identifying, monitoring, and acting on “key performance indicators” of “organizational performance” across various functions in an organization, including “asset management” and “sustainability management”, as well as contexts (e.g., “humanitarian supply chain”).

The subsequent prominent theme in this phase is customer orientation (dark pink cluster). This is a recurring theme from the previous decade (2002–2011) that has expanded in the recent decade (2012–2023). The keyword co-occurrences show that “customer satisfaction” should be a central consideration among organizations from commercial (e.g., “new product development”) and non-commercial (e.g., “sustainability performance”) perspectives. The “theory of constraints” is also a noteworthy theory that has informed research in this space, showing that organizations will need to balance economic, environmental, and social considerations when serving customers today who are becoming increasingly sustainability conscious.

The recent timeframe also marks the BSC’s utility in in financial management (dark green cluster). This is partially a recurring theme from the previous decade (2002–2011) on financial and human resource management that has shrunk in focus and size in the recent decade (2012–2023). The co-occurrence analysis of keywords shows that “integrated reporting” and the “banking industry” are key topics under this theme. Nonetheless, it is likely that this theme will disappear in the future, potentially merging into the second major theme in the present decade (i.e., integrated reporting ).

The evolution of the themes in BSC research from 2012 to 2023 mirrors broader changes in the global business environment. The persistence and dominance of strategic performance management as a theme underscore its continued relevance in navigating complex market dynamics and enhancing organizational efficacy. The seamless integration of strategy with performance metrics remains vital for organizations aiming for longevity and sustained success. This is also in line with the continued importance and relevance of strategic leadership (Singh et al. 2023 ).

Additionally, the burgeoning emphasis on sustainability themes, as seen with sustainability balanced scorecard and sustainable development , resonates with the escalating global awareness around environmental and social issues. This period witnessed unprecedented global consensus on the urgency of addressing climate change, conserving biodiversity, and ensuring social justice, as enshrined in global agendas like the United Nations’ Sustainable Development Goals and the Paris Accords in response to global challenges like climate change and poverty (Azmat et al. 2023 ; Lim 2022a ). Noteworthily, businesses today are no longer mere economic entities; they are entrusted with larger societal responsibilities. Their performance metrics, thus, have evolved to reflect a balance of economic prosperity, environmental stewardship, and social responsibility.

Besides that, the emergence of integrated reporting and its subsequent growth signifies the world’s growing demand for transparency and accountability in business. Stakeholders today, from investors to consumers, seek a holistic understanding of a company’s operations, encompassing not just financial metrics but also that on environmental, social, and governance (ESG) (Bansal et al. 2023 ; Lim, Ciasullo et al. 2023 ; Mahajan et al. 2023 ). This comprehensive view provides a clearer picture of a company’s ethical stance and long-term viability.

Furthermore, the rise in systems thinking reflects the world’s growing interconnectedness (Sandberg and Abrahamsson 2022 ). Businesses today operate in intricate networks, from supply chains that span continents to digital platforms that link disparate entities (Kumar et al. 2023 ; Sahoo et al. 2023 ). A systems perspective allows organizations to make sense of these complexities and understand the ripple effects of their decisions, ensuring that strategies are both holistic and adaptive.

Moreover, customer orientation’s continued relevance points to the changing dynamics of the customer-business relationship. Today’s customers are more informed, empowered, and discerning (Lim 2019 , 2020a , b ). Their preferences have shifted towards businesses that not only provide quality products and services but also align with their values, especially around sustainability (Lim 2022a , b ). This shift is not just a trend but a deeper societal transformation, highlighting the role businesses play in shaping and being shaped by societal norms.

Lastly, the potential phasing out of the financial reporting theme in favor of integrated reporting underscores a transition in business reporting paradigms. While financial metrics remain crucial, they are increasingly seen as one facet of a multi-dimensional performance narrative, which includes ESG dimensions (Lim, Ciasullo et al. 2023 ). As businesses and their stakeholders become more attuned to this holistic performance perspective, themes that once stood distinct are likely to merge, reflecting a more integrated understanding of business success.

5 Conclusion

5.1 key takeaways.

The present study offers a systematic review of BSC research over three decades (1992–2023) since the strategic performance measurement and management tool was originally developed by Kaplan and Norton ( 1992 ) and published in Harvard Business Review . Using bibliometric analysis involving performance analysis and science mapping via co-authorship analysis and co-occurrence analysis of keywords, this study has unpacked nuanced insights pertaining to (i) the publication trend, (ii) the top journals, (iii) the most influential (global citation) and prestigious (local citations by highly cited articles) publications, (iv) the major author groups, (v) the country collaboration network, and (vi) the major themes and topics for BSC research. This study revealed that BSC research is (i) on a bell-curve trajectory, (ii) published in multidisciplinary high-quality journals, (iii) contributed by numerous author groups around the world, and (iv) expanded in terms of its nomological network of thematic and topical coverage over three decades since existence (1992–2023). The declining trend in the productivity and popularity of BSC research is concerning. However, this issue could be addressed by introducing new ideas that would revitalize the BSC and establish its relevance to current management practices, which is in line with the goal of review studies such as the one herein and thus will be discussed further in the following section.

5.2 Future directions

Moving forward, there is a clear need to stimulate new, meaningful BSC research in order to correct its publication trajectory towards a direction reflecting positive growth. Reflecting on the evolution of major themes in BSC research (Figs.  4 , 5 , 6 ), three potentially fruitful directions for future research are proposed.

Co-occurrence network of author keywords for BSC research between 1992 and 2001. Notes Theme 1 = Performance management (purple cluster). Theme 2 = Knowledge management (orange cluster). Theme 3 = Strategic planning (dark green cluster)

Co-occurrence network of author keywords for BSC research between 2002 and 2011. Notes Theme 1 = Strategic performance management (pink cluster). Theme 2 = Customer orientation (black cluster). Theme 3 = Financial and human resource management (light green cluster). Theme 4 = Corporate governance (orange cluster). Theme 5 = Financial reporting (light blue cluster). Theme 6 = Knowledge management (dark pink cluster) (colour figure online)

Co-occurrence network of author keywords for BSC research between 2012 and 2023. Notes Theme 1 = Strategic performance management (pink cluster). Theme 2 = Integrated reporting (black cluster). Theme 3 = Sustainability balanced scorecard (light green cluster). Theme 4 = Sustainable development (orange cluster). Theme 5 = Systems thinking (light blue cluster). Theme 6 = Customer orientation (dark pink cluster). Theme 7 = Financial management (dark green cluster) (colour figure online)

First , many organizations around the world have suffered from the adversity of the unprecedented COVID-19 pandemic (Islam 2023 ; Sarwar et al. 2023 ; Sutarto et al. 2022 ). With the changes in customer behavior and the global marketplace (Lim, Kumar et al. 2023a , b ), the importance of financial resilience (Baker et al. 2023 ), and the ability to adapt to externalities with agility being noteworthy contemporary lessons (Heidt et al. 2023 ), especially following the COVID-19 pandemic (Lim 2021 , b ), it is important that future BSC research explore and propose suitable modifications and mechanisms to the BSC to improve its utility and relevance in the new normal. Such efforts should strive to enhance the adaptability of the BSC and educate organizations on how they can go about adapting the BSC in response to externalities with greater agility, efficiency, effectiveness, and success. This should contribute to meaningful extensions to BSC’s body of knowledge on strategic performance management .

Second , continuing BSC research on integrated reporting is highly encouraged in light of growing sustainability issues (Castillo 2022 ; Lim 2022a ) and stakeholder pressures to hold organizations accountable for their economic, environmental, and societal impact (Lim, Ciasullo et al. 2023 ; Tipu 2022 ). While many organizations have begun to participate in environmental social governance (ESG) activities and reporting, they may be doing so for reasons associated to compliance (Kotzian 2023 ; Prasad et al. 2022 ) rather than continuous improvement (Lim, Ciasullo et al. 2023 ). In this regard, the BSC, which links strategy, measures, and initiatives, could play a crucial role in driving purpose in organizational activities and the reporting of such activities. Therefore, future studies are encouraged to explore the role of the BSC and how this strategic performance measurement and management tool can be used to enhance the activity and outcome of integrated reporting (Fig.  7 ).

The evolution of BSC research (1992–2023)

Third , the importance of sustainable development has never been greater following the COVID-19 pandemic, where the world has regressed rather than improved in its performance across the sustainable development goals (Lim 2022a ). Taking a leaf out of this noteworthy observation, future BSC research must explore new ways to extrapolate the BSC for the purpose of making better progress towards sustainable development. New research in this direction should also adopt a systems thinking approach, ensuring that no stakeholder gets left behind, as well as a customer orientation approach, so that initiatives are developed, implemented, and monitored with the all potential beneficiaries in mind. It also important that financial viability and value maximization are always kept in mind, and add-ons to the BSC that can support organizations in doing so should be potentially fruitful. This is also logical given that the BSC is not a superior replacement but rather a complementary strategic performance measurement and management tool. Such efforts in this direction should therefore make profound contributions to the upgrade of the sustainability balanced scorecard , the utility of systems thinking and customer orientation , the extension of scope for financial management , as well as the impact of the BSC on sustainable development .

Finally , new research that explores new-age technologies such as artificial intelligence (Åström et al. 2022 ; Santana and Díaz-Fernández 2023 ) and blockchain (Alaassar et al. 2023 ; Sun et al. 2023 ) is highly encouraged to ensure that the BSC continues to stay relevant in the latest industrial revolution (Calderon-Monge and Ribeiro-Soriano 2023 ). Numerous scholars have showcased the use of innovative methodologies (e.g., fuzzy analytic network process-based approach to the BSC for collaborative decision-making; Bhattacharya et al. 2014 ) to enhance the efficacy and impact of the BSC. However, new efforts should be made to explore how managers can use artificial intelligence to automate the BSC and develop useful information that can help them take timely actions. Similarly, the utility of blockchain for measuring and monitoring initiatives on the BSC should also be explored, including the ways how this could be implemented. Such efforts, when taken collectively, should extend the scope of BSC research meaningfully, and hopefully, put the progress of the field back on a positive growth trajectory.

5.3 Limitations

Albeit the retrospective and prospective contributions that we have delivered herein, we concede several limitations, which, when viewed positively, may pave a meaningful way for future review studies on the BSC.

First , this study remains constrained to overarching insights on 31 ½ years of the BSC. While the bibliometric analysis did provide a comprehensive analysis of the performance and a rigorous mapping of the science in BSC research, it could not deliver finer-grained insights pertaining to the constructs, relationships, and potential tensions and contradictory findings in the field. In this regard, future scope avails for new reviews that invest attention to any of the major themes revealed through the present study—an endeavor consistent with Lim et al. ( 2022a , b ), who emphasized that review studies should not be viewed in competition but rather as a collaborative effort to enrich understanding of the field’s progress in multifaceted ways.

Second , this study is limited to the studies that were available on Scopus. In addition, best efforts were taken to ensure that no predatory journals were included in the review by utilizing established rating and ranking mechanisms as quality filters. Nonetheless, there is a possibility that new and emerging ideas may have been overlooked, since this study did not consider conference papers nor alternative publication outlets other than journals. While this was a justified decision on the basis that journals often published completed work (rather than work in progress) and that quality filters help weed out potential low-quality research findings, it cannot be discounted that certain insights or perspectives could have been overlooked in this study. As we do not wish to encourage new review studies to consider alternative outlets or sources unnecessarily, we believe that a more pragmatic suggestion would be to engage in new reviews of the BSC periodically. This could be done for BSC in general or in specific contexts (e.g., geographic regions, industries), thereby providing updated insights from new perspectives in meaningful ways.

Taken collectively, this article has delivered on its goals using an established review method, and thus, the insights that it delivers should be useful for gaining a comprehensive and updated understanding as well as a source of inspiration for the next generation of BSC research.

The phrase “over three decades” is used as it generally refers to a time span that is more than 30 years. If the period were exactly 30 years, one would typically say “three decades”. Therefore, “over three decades” implies a duration extending beyond the 30-year mark.

On the grounds of pragmatism, the co-authorship analysis was limited to (i) authors who have published a minimum of three studies on the BSC, and (ii) authors who have collaborated with more than two authors for BSC research.

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The deployment of balanced scorecard in health care organizations: is it beneficial? A systematic review

• Faten Amer   ORCID: orcid.org/0000-0002-5214-3797 1 , 2 ,
• Sahar Hammoud 1 ,
• Haitham Khatatbeh 1 ,
• Szimonetta Lohner 3 ,
• Imre Boncz 2 &
• Dóra Endrei 2  

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A Correction to this article was published on 10 February 2022

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Balanced Scorecard (BSC) has been implemented for three decades to evaluate and improve the performance of organizations. To the best of the researchers’ knowledge, no previous systematic review has performed a comprehensive and rigorous methodological approach to figure out the impact of BSC implementation in Health Care Organizations (HCO).

The current work was intended to assess the impact of implementing the BSC on Health Care Workers’ (HCW) satisfaction, patient satisfaction, and financial performance.

The authors prepared the present systematic review according to PRISMA guidelines. Further, the authors customized the search strategy for PubMed, Embase, Cochrane, Google Scholar databases, and Google’s search engine. The obtained studies were screened to isolate those measuring scores related to HCW satisfaction, patient satisfaction, and financial performance. The Risk of Bias (RoB) in the non-Randomized Intervention Studies (ROBINS-I) tool was used to assess the quality of observational and quasi-experimental studies. On the other hand, for the Randomized Controlled Trials (RCTs), the Cochrane (RoB 2) tool was used.

Out of 4031 studies, the researchers included 20 studies that measured the impact of BSC on one or more of the three entities (HCW satisfaction, patient satisfaction, and financial performance). Throughout these 20 studies, it was found that 17 studies measured the impact of the BSC on patient satisfaction, seven studies measured the impact on HCW satisfaction, and 12 studies measured the impact on financial performance.

This systematic review provides managers and policymakers with evidence to support utilizing BSC in the health care sector. BSC implementation demonstrated positive outcomes for patient satisfaction and the financial performance of HCOs. However, only a mild impact was demonstrated for effects related to HCW satisfaction. However, it is worth noting that many of the studies reflected a high RoB, which may have affected the impacts on the three primary outcomes measured. As such, this systematic review reflects the necessity for further focus on this area in the future. Moreover, future research is encouraged to measure the real and current impact of implementing BSC in HCO during the pandemic since we did not find any.

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Introduction

Since its development by Norton and Kaplan in 1992 [ 1 ], the Balanced Scorecard (BSC) has been utilized by many health care managers for the performance evaluation (P.E.) of Health Care Organizations (HCO) worldwide. Moreover, BSC can also be used as a strategic managerial tool by linking it to the organization’s strategy [ 2 ].

The first generation of the BSC was used to evaluate four organizational perspectives: the financial perspective, the customers’ perspective, the internal processes’ perspective, and finally, the learning and growth perspective, all of which were steered by the organizational vision and strategy [ 1 ]. See Fig.  1 . In this regard, it should be noted that a recent review re-categorized the BSC four perspectives for HCO into further 45 sub-dimensions or categories [ 3 ]. In the second generation of BSC, strategic maps were added to describe the cause-effect relationships between strategic objectives of each perspective [ 4 ]. In the third generation of BSC, destination statements, measures, and action plans were added to achieve the intended targets [ 5 ]. It is worth mentioning that Duke Children’s Hospital in the United States of America (USA) was the first HCO to implement BSC in 2000. As a result, the hospital was able to convert 11 million dollars of losses into four million dollars of profits [ 6 ]. See Fig.  2 , which shows Duke University’s health system strategic map [ 7 ]. The BSC strategic maps show that the process flow of the cause-and-effect relationships ends with the customer and financial perspectives [ 4 , 8 ].

Balanced Scorecard Perspectives [ 1 ].

Duke University Health System Strategic Map [ 7 ]

More recently, the pandemic of Coronavirus Disease 2019 (COVID-19) imposed financial burdens on many countries and health care systems worldwide. In addition, the pandemic increased the psychological stress of patients and HCW [ 3 , 9 , 10 ]. Moreover, implementing tasks with particular standards and guidelines was vital in tackling the spread of COVID-19 [ 11 ]. However, conflicting managerial decisions and the lack of standardization capability were factors that brought dissatisfaction about HCO [ 12 ]. Consequently, it is deemed essential to evaluate previous BSC implementation’s effectiveness in HCO and determine if actual benefits remain to justify their continued use. It is worth noting that numerous systematic reviews regarding the impact of BSC implementation in non-health care-related fields, such as architecture [ 13 ], management, marketing, and accounting, already exist [ 14 ]. However, BSC reviews in health care only described the application of BSC or its perspectives [ 3 , 15 ]. They lacked evaluation of the effectiveness of using BSC in HCO through systematically reviewed and evaluated literature. In this regard, only two reviews discussed the impact of BSC; one discussed the impact qualitatively [ 16 ], while the other mentioned a few examples of the positive impact [ 8 ]. To reiterate, this indicates that, until now, no comprehensive or rigorous methodological approach to assess the impact of BSC implementation in HCO has been recorded. Based on this gap in the literature, it was deemed essential to determine whether the previous BSC implementations at HCO were beneficial.

Thus, the present systematic review aims to gather all studies which have measured the impact of implementing BSC on HCW satisfaction, patient satisfaction, and financial performance at HCO; particularly, since these three attributes represent the latest affected perspectives in the strategic maps [ 4 , 8 ]. Further, this review aims to assess and compare results among the included studies.

Materials and methods

Our previous systematic review analyzed the dimensions and indicators of BSC utilized at the P.E. of HCO [ 3 ]. This systematic review was carried out by finding all studies that approached BSC implementation’s impact in HCO in adherence with the 27-point of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [ 17 ]. See (S 1 Appendix).

Eligibility criteria

The inclusion and exclusion criteria were set as shown in Table  1 below.

Data sources, search strategy, and study selection

In the present systematic review, the search strategy was developed by the first, second, and fourth authors; because the first two authors are experts in health care management and BSC, and the fourth author is an expert in systematic reviews and meta-analysis. The search strategy was initially developed for the PubMed database based on the PICO (Population, Intervention, Comparison, and Outcome) tool [ 18 ], and depending on using both MeSH (Medical Subject Headings) terms and keywords. See (Table 1 ). Next, the strategy was adapted to Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Google Scholar databases, as per Cochrane’s recommendations [ 19 ]. The strategies developed for these databases can be found in (S 2 Appendix).

The grey literature, pre-prints, and unpublished studies were searched on Google Scholar and Google’s search engine websites to reduce publication bias. Furthermore, the authors attempted to identify other potentially eligible studies or ancillary publications by searching the reference lists of any potentially eligible studies. The databases were searched until October 2020. Afterward, the first author conducted the search strategies on the electronic databases and removed the duplicates using the EndNote X9.2 program.

The first and second authors independently performed the selection of eligible studies. A discussion after each step was made or, if necessary, the third author was consulted for arbitration in case of disagreements. Initially, the titles and abstracts of the studies were examined to eliminate irrelevant studies. In the second step, the full texts of all potentially relevant studies were carefully reviewed to make a final decision based on the criteria mentioned above. Authors of studies with no available full texts or unclear impact duration were contacted to obtain further details and clarification.

Data extraction and analysis

The following types of data were extracted from each of the final eligible studies: 1) author/s, year of publication, 2) country, 3) type of study, 4) duration of data collection 5) setting, 6) the number of health facilities, 7) number of participants, 8) data collection tool or data source, and 9) outcome (impact on patient satisfaction, HCW satisfaction, and financial performance). The data extraction was carried out independently between January and March 2021 by the first and second authors.

The research design of eligible studies was extracted directly from them. In case the research design was not explicitly mentioned, it was determined based on the role of the investigator of a given study. Specifically, if the BSC exposures were naturally determined and the investigator had no part, the study was considered observational. On the other hand, when the investigator assigned the BSC intervention, the study was deemed to be experimental.

The impact of BSC in eligible studies was explicitly mentioned or determined by calculating the difference between before and after implementation values. After that, the unification of the units was performed. Next, charts plotting for each outcome were performed by the first author and then reviewed by the first and second authors separately. If the impact measurement unit was not reported in the eligible studies, the authors of these studies were contacted. Lastly, all differences were compared, discussed, and judged by the two authors in the final step.

Quality assessment

The Risk of Bias (RoB) assessment was performed by the first and second authors independently between March and June 2021 to assess the quality of the included studies. As per the Cochrane collaboration’s guidelines, the Cochrane (RoB 2) tool was used for the assessment of randomized controlled trials (RCTs) [ 20 ]. The Risk of Bias in non-Randomized Intervention Studies (ROBINS-I) tool was used to assess the observational and quasi-experimental studies [ 21 ]. As per the Cochrane Handbook, authors should avoid summarizing the overall RoB [ 22 , 23 ]. Therefore, the RoB was analyzed at the study level and across studies.

In (RoB 2) tool, five types of bias were assessed: bias arising from the randomization processes, bias due to deviations from intended interventions, bias due to missing outcome data, bias in the measurement of outcomes, and bias in the selection of the reported results.

On the other hand, in the ROBINS-I tool, seven types of bias were assessed: bias due to confounding, bias in the selection of participants in a study, bias in measurement/classification of interventions/ exposures, bias due to deviations from intended interventions/ exposures, bias due to missing data, bias in the measurement of the outcomes, bias in the selection of the reported results.

While using the RoB 2 tool, each type of bias was assessed as low, high, or unclear. While using the ROBINS-I tool, each type of bias was evaluated into five categories: low, moderate, serious, critical, or no information. Afterward, the assessment results of the two reviewers were compared. Where there was disagreement, the fifth and sixth authors were consulted. Figures for RoB were prepared using the ROBVIS (Risk Of Bias VISualization) tool [ 24 ]. Lastly, it was recommended not to advocate quality appraisal as a criterion for inclusion in reviews [ 25 ]. Therefore, the authors decided to include all studies in this systematic review regardless of their quality assessment.

Study selection

Initially, the search strategy resulted in a total of 4031 studies. After removing the duplicates, a total of 2985 studies remained, which were screened based on their titles and abstracts. Then, irrelevant studies were excluded; thus, 202 studies remained. A careful examination of the included studies’ full texts was made; based on this, only 20 studies were finally included in the current systematic review. Details of the study selection process are shown in the PRISMA flow-chart (Fig.  3 ).

PRISMA Flow Diagram

Study characteristics

The main characteristics of the included studies are shown in Table  2 .

Location/ country

Regarding the implementation location, nine studies were implemented in North America, two in Europe, one in Africa, seven in Asia, and one did not specify the location. It should be noted that 14 studies were performed in high-income countries, two in upper-middle-income countries, one in a lower-middle country, and only two in low-income countries.

Out of the 20 selected studies, 16 were performed in hospitals or hospital departments, and four in health care facilities or clinics. See Table 2 .

Even though no limitation was imposed on language, all of the selected 20 studies measuring the impact of BSC implementation were written in English.

Study designs

Out of the 20 selected studies, only three studies reported their study designs explicitly. However, our classification showed that 11 studies were observational since the investigators were not involved in implementing BSC; instead, these investigators only observed the results of already implemented BSCs at HCO. On the other hand, the remaining nine studies were experimental. One out of the nine was RCT, while the other eight were quasi-experimental studies, which included three pretest-posttest components and five Interrupted Time Series. See Table 2 . Notably, only three studies [ 32 , 36 , 37 ] randomly selected HCO, participants, or both.

Variations regarding the data collection instruments

Variances among the data collection instruments used in the 20 studies are shown in Table 2 . Notably, the employed instruments were validated only in six studies [ 27 , 28 , 32 , 35 , 39 , 42 ]. Additionally, only five studies [ 27 , 28 , 39 , 42 , 43 ] assessed the instruments’ feasibility. The pre-testing of the instruments was carried out only in three studies [ 27 , 32 , 35 ]. In addition, only five studies [ 27 , 31 , 38 , 42 , 43 ] assigned weights for the indicators or assessed their importance before implementation. Further, only one study [ 29 ] evaluated the indicators depending on more than one source for the same variable.

BSC generations

The 20 studies chosen for this systematic review utilized different BSC generations. The first generation of BSC was employed in seven studies [ 28 , 29 , 30 , 31 , 33 , 39 , 42 ] which discussed explanations, the definition of perspectives and indicators, and how to measure each indicator. Besides these seven studies, one other study [ 34 ] used the first generation BSC; however, only customer and patient satisfaction were explained in the way they were measured. Further, only five of the 20 studies [ 27 , 28 , 29 , 30 , 33 ] specified the source for each perspective/indicator, while one study [ 42 ] mentioned them partially.

The aspects of BSC’s second-generation were found in five of the 20 studies [ 26 , 28 , 29 , 31 , 34 ], where users modified the objectives of each indicator during implementation to suit strategy, vision, mission, and goals. Additionally, two other studies [ 42 , 43 ] modified these objectives partially but failed to explain them sufficiently. Further, strategic maps were only illustrated in six studies [ 26 , 28 , 31 , 33 , 38 , 40 ]. Finally, it is worth noting that only three studies [ 28 , 29 , 31 ] displayed the cause-effect cascade between indicators and targets.

Regarding the third generation’s aspects, seven of the 20 studies [ 26 , 28 , 29 , 30 , 31 , 33 , 34 ] approached destination statements or targets within a time horizon. Besides, one study [ 6 ] approached the length of stay indicator only. Additionally, only one study [ 26 ] approached strategic initiatives or action plans to achieve the targeted performance.

BSC’s impact type

The included studies assessed different outcomes for implementing BSC. Out of the final 20 eligible studies, 17 studies [ 6 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 42 , 43 , 44 ] measured the impact of BSC on patient satisfaction, 7 measured HCW satisfaction [ 27 , 28 , 29 , 30 , 36 , 37 , 45 ], and 12 studies measured financial performance [ 6 , 27 , 28 , 29 , 30 , 33 , 34 , 40 , 41 , 43 , 44 , 45 ]. However, the measured variables varied among studies, even in terms of the same dependent variable (Figs. 4 , 5 , 6 , 7 ). For example, BSC’s impact on patient satisfaction varied from overall satisfaction to the satisfaction of specific categories, such as adults, children, inpatients, outpatients, patients in the emergency room, patients in rehabilitation. In addition, the measured variables varied based on the service type, such as satisfaction of home care services and departmental services.

Patient Satisfaction Impact. Increase or decrease in patient satisfaction rate after BSC implementation (%)

HCW Satisfaction Impact. Increase or decrease in HCW satisfaction rate after BSC implementation (%)

Financial Impact (%). Increase or decrease in financial performance after BSC implementation (%)

Financial Impact (USD). Increase or decrease in financial performance after BSC implementation (USD)

Regarding HCW satisfaction, the name assigned to the targeted population varied from staff, employees to HCW. Further, the HCW satisfaction type varied, for instance, from HCW satisfaction towards their job to HCW satisfaction towards their superiors. However, the financial variable had the greatest variation among all three primary outcomes measured. Specifically, it was found that there exists a reduction in costs, expenditures, HCW budget, expenses, catering expenses, expenses/net revenues, bad debt expenses per net revenue, and supply per net revenue. On the other hand, an increase in revenues types included; returns, profits, aggregate surplus, funds, the value of drug-related groups, and return on assets.

Moreover, the unit used for financial impact assessment differed among studies. For example, all studies used currencies for assessment, where these currencies also varied between studies, except for a few studies [ 27 , 33 , 34 ] which used a percentage method. As an attempt to reduce bias, all currencies were converted to United States Dollar to standardize and make the comparison across studies more consistent regarding the financial outcomes in the systematic review. Further, the authors of one study [ 28 ] were contacted for clarification since they did not report the currency. As a result, Figs.  6 and 7 were designed as seen below; one for the impact in currencies and the other for the impact in percentages.

Most studies used a percentage score to measure the impact on patient and HCW satisfaction, except for three studies [ 28 , 30 , 45 ], which performed the measurement based on a four or five point-Likert scale. However, to make the comparison consistent, all Likert scales were converted to percentages (scores out of 100%). It should be noted that only two of the 20 studies [ 35 , 45 ] discussed the statistical significance of the results. Hence, the magnitude of change (in percentage) was taken into consideration in our analysis.

Time of measuring the outcomes

To make an objective comparison and avoid falling into bias, we reported the time between implementing BSC and assessing its impact in the included studies. Further analysis demonstrated that the intervals between the initiation of BSC implementations and the measurements of impacts varied among studies. In particular, one study [ 29 ] reported the results based on 18 months of implementation, two studies [ 38 , 44 ] took 2 years, one study [ 45 ] took 3 years, two studies [ 6 , 35 ] took 4 years, and one study [ 28 ] took 7 years of implementation. The remaining 13 studies reported results based on 1 year of implementation. Due to the previously mentioned variations in measured variables, duration of implementing BSC, and differences in data collection instruments or data sources, refer to (Table 2 ), the authors decided that conducting a meta-analysis would not lead to meaningful results. Instead, a comparison of the impact was performed using the bar charts. See (Figs. 4 , 5 , 6 , 7 ).

The impact of BSC implementation

The outcomes of BSC implementation in each of the 20 included studies are shown above in (Figs. 4 , 5 , 6 , 7 ), which illustrate the impact on patient satisfaction, HCW satisfaction, and financial performance (in percentage and currency). The exact impact type and duration were specified for each measurement, and the results are discussed further in the discussion section below.

Since we did not limit our search strategy to the three BSC impacts defined in our aim, eight studies of different impact types resulted in the abstract screening process. Examples of the other BSC impact types include; influencing the market share, the number of new patients, the number of consultations and visits, community satisfaction, percentage of residents receiving outreach activities, number of sampled children, availability of essential drugs, and decreasing the average length of stay [ 46 , 47 ]. However, after reading the full texts, the authors decided to exclude these studies as they lacked sufficient relevance to our research aim. See (S 3 Appendix).

As illustrated in S 4 Appendix, each study was evaluated in terms of RoB. For that purpose, the RoB 2 tool was employed to assess the sole RCT study [ 32 ], in which the assessment was deemed fair, except for the performance bias. On the other hand, the RoB in the quasi-experimental and observational studies was measured using the ROBINS-I tool; and it was found that there was no information about analysis methods of confounders’ adjustments except in four studies [ 33 , 36 , 39 , 42 ]. The confounding agents were apparent in three studies [ 27 , 35 , 37 ]. However, the three studies failed to adjust for the confounders, which may have affected the precision of the measurement.

Furthermore, the selection bias across studies reflected serious RoB in five studies [ 27 , 30 , 31 , 33 , 40 ]. A possible reason the intervention and the follow-up did not coincide together and a potentially substantial amount of follow-up time was missing in the analyses. The moderate risk of bias showed that the intervention status was well defined, but some aspects of the assignments of intervention status were determined retrospectively. Further, outcome measurements bias was raised either due to the non-blinding of intervention among assessors [ 37 ] or because the outcome measure was subjective and likely to be influenced by other factors [ 29 , 38 ]. See (S 4 Appendix).

Discussion of the main results

This systematic review aimed to identify all the studies which measured the impact of BSC implementation on three variables: HCW satisfaction, patient satisfaction, and financial performance at HCO, and then proceeded to analyze the effect of these BSC implementations.

The analysis of the results reflected a remarkably positive impact of BSC on patient satisfaction in most studies. The same positive impact of BSC implementation holds for financial performance in both currency and percentage indicators. Notably, the authors found that almost all studies showed a positive impact, amounting to several million dollars. However, a few studies reflected a moderately negative impact on financial performance, which form three distinct categories. The first category includes study [ 29 ], which explained the occurrence of unintended events that may have negatively affected financial performance. The second category comprises studies [ 30 , 40 ] that revealed a highly positive impact on financial performance in previous or subsequent years, which may reflect a sloth in following up. The third category includes studies [ 28 , 39 ] that showed a positive impact on financial performance on one or more of the other impact types. On the other hand, the analysis of BSC impact for HCW satisfaction revealed a less remarkably positive impact. See (Figs. 4 , 5 , 6 , 7 ).

Agreements and disagreements with other studies or reviews

The findings obtained from the present systematic review are in line with a systematic review [ 14 ] that reviewed BSC’s benefits in business, management, and accounting fields. Furthermore, the present study is the first to summarize all BSC implementations and their impacts on the health care sector based on quantitative comparisons. Moreover, the current study was compared with other reviews in the health care sector. For instance, a review [ 15 ] carried out a mere description regarding the application of BSC. In contrast, a review [ 3 ] only summarized the perspectives and dimensions utilized. Lastly, a review [ 16 ] only mentioned examples about BSC impact.

One probable explanation for the mild impact on HCW satisfaction can be referred to the lack of managerial engagement with the non-managerial HCW upon BSC implementation, the lack of understanding by HCW about the advantages of BSC implementation s, or the fear of potential responsibility and accountability placed upon HCW due to BSC implementation. As a result, HCW may have declined to implement BSC, contributing to a lower satisfaction score. In conclusion, future researchers should consider increasing employee participation in BSC implementations.

For instance, in a study [ 29 ], the employees did not have incentives or motives to participate in BSC since they were permanent employees. Further, the study showed that HCW above 40 years old negatively influenced creativity and productivity upon BSC implementation. Other researchers in [ 48 ] also referred to this challenge, who noted that major deficiencies arose from qualified personnel and HCW aging. However, those researchers have also suggested that the high-ranking qualifications of HCW, driving learning and a growth perspective, will eventually generate motivation for new HCW to resolve this issue. Other proposed ideas to solve this problem were creating an open environment for learning and growth and encouraging active communication with HCW to ensure the successful implementation of BSC. Other researchers [ 49 ] encouraged senior management commitments to involve non-managerial HCW, promoting clear articulation of benefits and relevancy of BSC to clinicians. This challenge mirrors the findings of another review [ 50 ], which realized that the attitude perceived by health care professionals of accreditation was negative and skeptical because of quality concerns regarding services and their cost. Therefore, the authors in the latter study suggested that health care professionals, especially physicians, require more intensive education about the potential benefits of accreditation.

Finally, the quality assessment revealed that many studies had high RoB, which may have affected the impact results. A recommendation for the researchers and managers implementing BSC in the future is to dedicate more focus to raising the quality of implementation and lowering the RoB. Moreover, a better focus on the second and third generations of BSC aspects is essential.

Strengths and weaknesses

The current systematic review contains several strengths. To our knowledge, this is the first paper that has analyzed all the studies which measured the impact of BSC on patient satisfaction, HCW satisfaction, and financial performance in HCO. The results and analysis of this systemic review support a positive impact for applying BSC in HCO, especially on patient satisfaction and financial performance. Further, a greater emphasis on the role of HCW is required when implementing BSC since HCW satisfaction showed slightly positive, almost zero, or somewhat negative scores in most studies included.

Additionally, the three primary outcome measures concentrated upon in this systematic review are considered the last destination for impact in the strategic maps and the causal effects at most BSC studies. Finally, unlike other BSC reviews [ 8 , 16 ], which included definitions of biobanks, pharmacies, laboratories, radiology, and medical colleges in HCO, this review limited the definition to the primary, secondary, or tertiary health care organizations. This strategy leads to the homogeneity of the resulting studies and leads to more valid comparisons among the results.

Nevertheless, this paper has some limitations. First, it focused on the impact of BSC on the three chosen indicators only, whereas impacts on other types of indicators were not considered for analysis. Due to the vast variations of indicator types, analysis of these indicators presents a challenge, requiring narrowly specified modes of analysis. Secondly, no meta-analysis could be applied to this systematic review resulting from the heterogeneity of studies regarding their data collection tools and the enormous variation in the types of indicators. However, the later variation was clarified in the charts, and the data collection tool was specified for each study. Thirdly, the current review included studies that measured the impact after at least 1 year of implementation. Fourthly, it is essential to mention that the impact comparability is roughly more rational for patient satisfaction and HCW satisfaction than financial performance. This could be referred to as the comparison ability based on a percentage score of 100 for the satisfaction variables. Additionally, the change in financial performance based on currency could be influenced by other confounding factors such as the HCO size or the number of health facilities included in the study. Therefore, future studies should consider these confounding factors. Moreover, future studies should reduce the RoB due to the lack of high-quality BSC implementations in the literature. Finally, this review searched for the BSC implementation in health care databases; consequently, future systematic reviews are recommended to include studies in management and health policy databases.

Conclusions

In conclusion, this systemic review offers evidence to HCO and policymakers on the benefits of implementing BSC in HCO. Although the quality assessment revealed that many studies had a high RoB, BSC implementation positively influenced HCO patient satisfaction and financial performance. Based on the findings in the present review, researchers are encouraged to focus on lowering the risk of bias in BSC implementation in the future. HCO managers are also advised to consider HCW satisfaction and engagement with BSC implementations. Finally, an additional assessment of the BSC impact in HCO during the COVID-19 pandemic is required, as we could not find any.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Change history

10 february 2022.

A Correction to this paper has been published: https://doi.org/10.1186/s12913-022-07555-9

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Acknowledgments

We would like to thank Dr. Vahideh Moghaddam, Diêgo Andrade, and Wang Zhe for their help in translating and data extraction of Persian, Spanish, and Chinese studies, respectively. Also, we would like to thank Dr. Duha Shellah, Dr. Mohanad Khatatbeh, Dr. Ibrahim A. Shilbaya, Mr. Jason Titman for revising the manuscript.

The research was financed by the Thematic Excellence Program 2020—Institutional Excellence Sub-programme / National Excellence Sub-program of the Ministry for Innovation and Technology in Hungary, within the framework of the 2. thematic and Biomedical Engineering programme of the University of Pécs. Code: 2020–4.1.1-TEP2020.

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This systematic review was planned and designed by F.A, S.L, S.H., I.B & D.E. Specifically, F.A & S.H performed the processes of searching for eligible studies and data extraction. F. A & S. H performed the interpretation of the data. F. A completed the current systematic review, and all of the authors participated in revising the manuscript. S.L., I.B & D.E supervised this systematic review. Ultimately, all of the authors approved the final manuscript and agreed to be personally accountable for the author’s contributions and ensure the accuracy and integrity of any part of the work are appropriately investigated and resolved.

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Development of a balanced scorecard as a strategic performance measurement system for clinical radiology as a cost center

• Ulf Teichgräber   ORCID: orcid.org/0000-0002-4048-3938 1 ,
• Rainer Sibbel 2 ,
• Andreas Heinrich 1 &
• Felix Güttler 1  

Insights into Imaging volume  12 , Article number:  69 ( 2021 ) Cite this article

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To develop a goal-oriented indicator system based on the balanced scorecard (BSC) concept, which takes into account the perspectives of the referring physician and patient and emphasizes the focus on the internal processes of the radiology department.

Development of a BSC occurred in six steps: (Step 1) strengths/weaknesses and opportunities/risks (SWOT-) analysis of the radiology department, (Step 2) setting-specific objectives (model, core values, key objective) followed by the development of 4 perspectives, (Step 3) and definition of strategic issues oriented to the value-added chain of the processes of the radiology department. (Step 4) Creation of a “Strategy Map” with regard to the perspective and their cause–effect relationships. (Step 5) Development of an automated key performance indicator (KPI) cockpit for the monitoring, reporting, and management scorecard.

A total of 10 success factors were identified using SWOT analysis. The core values include high quality in clinical, teaching, and research areas. The radiological value-added chain is composed of three processing steps. 1. registration, 2. examination, and 3. reading/X-ray demonstration. Three action programs were derived: 1. increase competency (e.g., specialist standard), 2. improve referring physician/patient satisfaction, 3. increase productivity. Daily process monitoring was added to the management cockpit as a monitoring scorecard. The scorecard comprises 18 KPIs and is automatically updated every month. The annual management scorecard comprises 10 KPIs.

Conclusions

The BSC makes it possible to implement a strategy for radiology that is strongly oriented toward the requirements of the referring physicians and the demands of patients.

The implantation of a Balanced Scorecard concept in radiology represents a strategic management tool, which takes into account the perspectives of the referring physician and patient and emphasizes on the internal processes of the radiology department.

Focusing on the value-added chain of the radiology department (process orientation) represents the fundamental idea of Balanced Scorecard for radiology.

Balanced Scorecard based monitoring can help to overcome the weaknesses of a traditionally budget-oriented reporting system.

Introduction

Radiology departments in a hospital function as a central internal cost center for other clinical departments and clinics (profit centers), such as the internal medicine, surgery, or emergency departments. As a rule, a radiology department usually is defined as a clinical institution with its own budget and cost responsibilities without its own wards (hospital beds) or outpatient clinics [ 1 , 2 ]. Radiological services are reimbursed through internal service accounting. The current reporting system for radiology comprises a cost- and revenue-based system of indicators based on annual budgets. The planning and management of services provided are based solely on cost and revenue elements.

While the revenue side is closely related to the type and number of examinations performed, the cost structure in a radiology department is characterized by high personnel costs (as is typical for hospitals) on the one side and high technology-related, fixed costs on the other. Smooth organization of the processes with respect to personnel deployment, patient waiting times, and diagnosis ensures effective cooperation with requesting and referring clinics as well as the efficiency of the department. Therefore, the focus of management in the radiology department and the greatest optimization potential is in the design and organization of work processes. Traditional reporting in the radiology department does not consist of special measured values and key performance indicators (KPIs) that document and evaluate the work processes. Therefore, it is necessary to expand the current reporting system to focus on factors such as the work processes and use of resources and to be able to achieve goal-directed planning and management of added value for both patients and referrers as primary clients.

Kaplan/Norton developed a multidimensional system of indicators at the beginning of the 1990s known as the balanced scorecard (BSC) to serve as a management concept for implementing strategies. BSC is a concept for measuring, documenting, and managing the activities of a business or an organization with regard to the implementation of its vision and strategy with the intention of balancing the four perspectives of the services [ 3 ]. BSC is a link between strategy development and implementation. The traditional financial strategy targets in this concept are added to the operational objectives relating to the client, internal process, and resource-oriented learning and development perspectives. The entire value-added chain in this system of indicators is presented in line with cause/effect relationships in the four target fields (perspectives):

Market and clients

Internal business processes/work processes

Learning and growth (innovation)/potential

Therefore, the perspectives should not be considered independently but in a hierarchical structure according to Kaplan and Norton [ 4 ]. Among other things, the right balance of the resulting system of indicators is that the objectives and parameters that are related classically to financial results are related to the customer, process, and personnel factors and drivers that influence them significantly. Furthermore, quality-oriented “soft” success factors such as result quality, processing times, adherence to appointments, innovation, motivation, and qualification of employees can be evaluated along with “hard” fact-based KPIs.

In Health Care Organizations, it becomes more important that department heads serve as strategic managers with the ability to evaluate a changing industry, analyze data, question assumptions, and develop new ideas [ 5 ]. Kaplan and Norton also concerned themselves with the implementation of the BSC concept in nonprofit organizations (NPOs) and have published several case studies on this topic [ 6 ]. They determine that too little attention is paid to the intended output during strategy development. Hospitals in Germany also are operated predominantly as public law corporations or nonprofit corporations. For this reason, they are also regarded as NPOs. Kaplan and Norton summarize their experience with NPOs as follows: “BSC projects often were built on hastily implemented quality management systems that aimed to improve processes. It was difficult to find an NPO that followed a strategy which included product leadership and a close association with clients” [ 6 ].

To address this lack of strategy-based management, Friedag and Schmidt have developed a highly practical approach to implementing BSC and have extended the concept to three consecutive scorecards (Fig.  1 ) [ 7 ]:

A Daily Monitoring Scorecard depicts the current performance with the aid of process key values.

A Monthly Reporting Scorecard replaces the monthly reporting system, summarizes the most important financial KPIs, adds to the internal processes (work processes) through use of KPIs, and links strategic management with operative controlling.

An annual balanced scorecard serves as the basis for an annual reporting, summarizing all perspectives and used for strategic management.

Deriving the scorecards from the four key perspectives

For the radiology department as the internal cost center of the hospital, there is a large potential for improvement both in the sense of quality and the cost efficiency of internal processes. Therefore, internal monitoring of work processes (e.g., determining examination times, headways, patient waiting times, examination revenue) offers itself as an addition to the report and annual balanced scorecards. Daily monitoring is conducive to operative management of the department. The results of process monitoring are included in the report and annual balanced scorecards in an aggregate form.

The development of the BSC for the radiology department at our university hospital and its service portfolio occurred over six steps (Fig.  2 ): (Step 1) The first step included a strengths/weaknesses and opportunities/risks (SWOT-) analysis for internal and external current state analysis of the radiology department as a cost center within the university hospital with regard to internal and external influencing factors and changes. The SWOT matrix below presents the opportunities and risks analyzed in relation to identified strengths and weaknesses to define the limits for subsequent, long-term-oriented departmental strategy.

Process steps to create a balanced scorecard for the radiology department

The second implementation step involved determining and defining the vision and the specific strategic objectives for the radiology department (model, fundamental values, key objective). The derivation of the key objective was performed through analyses of uniqueness, target clients, and the needs of their clients. The third implementation step was the development of four perspectives of the BSC design as well as the strategic areas of activity in the perspectives. The classical hierarchical arrangement of the perspectives according to Kaplan/Norton was modified in terms of the environment and for use in the radiology department. Instead of the financial perspective, the client perspective in terms of a cost center and the medical result dimensions was chosen as the highest hierarchical level. Unlike other clinical institutions in the hospital, the radiology department serves two categories of clients: patients and clinical referrers (other clinics within the hospital). We grouped both client categories as part of the client perspective, creating the patient and referrer perspective. This was then followed by the financial perspective, the internal process perspective and, finally, the employee perspective.

Strategic themes for each level based on this BSC structure were defined and oriented on the value-added chain of the processes in the radiology department. The radiological value-added chain consists of three basic process steps: 1. patient registration and the requested examination, 2. realization of the examination, and 3. findings/X-ray demonstration. Important time-dependent measured values in terms of process efficiency linked to these core processes were identified in a subsequent implementation step; these are closely linked to quality and profitability requirements on the client and financial levels.

The focus of the fourth implementation steps was the creation of a strategy map (Fig.  3 ), which presents the cause/effect relationships below between the strategic areas of activity in the perspectives as well as subsequent definition and selection of KPIs based on the measured values for each area of activity.

Strategy map of the radiology department

Next, potential KPIs based on the thematic focus as well as the area of activity regarding the other perspectives and their cause/effect relationships were identified, which could be consulted with objective-oriented assessment of each core aspect. Possible process KPIs could be derived, e.g., from automatically measurement timestamps from the radiological information system (RIS). In total, nine different timestamps were collected. Additional KPIs were collected through literature research. For the referrer and employee perspective, KPIs from the radiology department annual electronic referral and employee survey were available.

For the subsequent selection of KPIs for the BSC, a unique evaluation concept with the acronym CSTC was developed. Based on four quality criteria, all previously compiled KPIs were evaluated and prioritized using a numerical ranking scale based on Concision, Survey effort, Topicality and Clarity. The fifth implementation step consisted of a final selection and definition of KPIs using a Horváth and Partner filter as well as the derivation of action programs [ 8 ]. In the sixth implementation step, the KPI cockpit for the monitoring, report, and annual balanced scorecard was created. The respective scorecards should be created completely automatically and be viewed at any time over a web portal. The annual balanced scorecard and the monthly reporting scorecard should be updated monthly and daily internal process monitoring pursued.

SWOT analysis resulted in a complete picture of the current situation as well as the important challenges for the hospital and the radiology department as a basis for strategic planning (Table 1 ). From this, a total of 10 success factors for a sustainably successful strategic positioning could be identified. Radiology as a cost center was defined as a departmental model. The fundamental values include high quality in clinical, teaching, and research areas. The vision, as well as the key objective in the long term, is to be in the top 10 in terms of innovation and services amongst German university radiology departments. The strategic issues discussed are part of the value-added chain of the radiological work processes and are also the most important performance drivers. From the strategy map along with a systematic literature analysis, 34 KPIs could be extracted for the radiology department and the CSTC evaluation conducted. The number of KPIs for the monthly reporting scorecard could be reduced to 18 using the Horváth and Partner filter. As a result, three action programs for the radiology department were created. 1. increase in competency (specialist standard, MTRA training), 2. improvement in referring physician/patient satisfaction, 3. increase in productivity daily process monitoring was added to the management cockpit as a monitoring scorecard. The monthly reporting scorecard consists of 18 KPIs and is automatically updated on a monthly basis. The annual management scorecard comprises 10 KPIs, each of which has a KPI from the annual electronic employee and referrer survey (Table 2 ).

Mainline for-profit companies accepted BSCs in the meantime, but non-for-profit healthcare organizations were slow to adopt them for use. A number of problems face the healthcare industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how healthcare organizations, both profit and nonprofit, manage operations [ 9 ]. Already in 1998, Sahney demonstrated an approach how to apply a BSC in managed care organizations (MGOs) for measurement, development of strategy, and performance improvement. MGOs as healthcare providers are constantly facing the pressure of improving their financial performance in a highly competitive environment [ 10 ]. One of the first implementations of the BSC concept in the clinical environment was initiated by the Yale University School of Medicine in the field of Anaesthesiology published in 1999 demonstrating a great value to a department, even if the full implementation takes several years to complete [ 11 ]. In different healthcare sectors, the BSC concept is applied to support improved decision making and performance [ 12 , 13 , 14 , 15 , 16 , 17 ]. In order to attain a useful BSC in the healthcare sector, appropriate performance perspectives and indicators are crucial to reflect all strategies of the organization. It also requires medical staff to contribute in BSC development, which will result in greater reliability of the BSC [ 18 ].

In peer-reviewed journals in the medical field, there have only been two studies published on the application of BSC in a radiology department. An article from Mauer et al. presents a conceptual BSC for an academic university radiology department with focusing on teaching and research [ 19 ]. In this study, additional KPIs for teaching evaluation and examination grades were added to patient and referrer satisfaction from the client perspective. Additionally, five additional perspectives were suggested as a scientific perspective, which takes into consideration scientific publication output (number, impact factor) and the external funding secured. Academic university hospitals are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care [ 20 ]. The consideration of teaching and research in university medicine appears to be implied. In our present BSC, these important core tasks of the university radiology department have been ignored for the time being. Instead, the focus was placed on the clinical work processes to guarantee clarity and to limit where possible the number of KPIs in the BSC. In addition, at our university hospital, there is separate accounting for cost centers/budgets between clinical patient care and teaching and research. For that reason, it does not appear to make sense at present to take teaching and research into account in the same BSC. Rather, a second independent report and annual BSC should be established for teaching and research in parallel.

Donnelly et al. [ 21 ] present a case study for a BSC for a radiology department in a children’s hospital in the US Midwest. In this BSC, 33 KPIs in six perspectives were identified and designated as the department scorecard. The six perspectives are clinical service, teaching, research, patients, financial, and referrers. The BSC is created every quarter and available to all employees through an internet portal. It should be noted that the authors provided no cause–effect relationships between the KPIs. No information about the perspective hierarchy could be determined. The authors believe that the transparency of the KPIs for employees is essential to its use. They believe there is a motivation factor in the BSC for the employees, which is more effective than a financial incentive. The authors believe that establishing the BSC is an important instrument for quality improvement. The authors have noted improvement in 61% of KPIs, consistency in 33% of results, and a decline in only 6% of results over the 7 years since the implementation of the BSC [ 21 ].

The BSC concept allows for the development and implementation of a strategy for the radiology department, which is closely aligned with the requirements of the referring in- and outpatient clinics on the department as a cost center and considers patients to be the true clients. The BSC makes available a new management instrument for the radiology department of the Jena University Hospital with a measurable target not only to use existing potential efficiently but also to develop new potentials. The methodology of our BSC used and adjusted for the radiology department is not a cookbook recipe that can be used immediately for other clinical institutions and should always be adjusted methodically to align with the mission and the vision of each institution or hospital. Focusing on the value-added chain of the radiology department (process orientation) represents the fundamental idea of BSC for radiology. This approach can serve as a guide for other radiology departments at other hospitals when establishing a BSC. Individual KPIs can also certainly be used without modification. In these cases, it should be tested whether these align with the strategy and success factors of each institution. It is not recommended to simply adopt KPIs even within the same specialization.

After the implementation of our BSC, the different KPIs were used and accepted in different ways. The process KPIs showed their effect in daily monitoring. In addition, these process KPIs are made available to the internal referring clinical departments in monthly reports for the use of radiological services. KPIs such as the waiting time for examination appointments or radiological reports are the focus of interest. The annual BSC is used exclusively for the business planning and serves as an overview for the board of directors of our hospital for the operational results of the radiology department. For the personnel requirement calculation, the total performance figures, the utilization of the devices, and the minute-by-minute staff retention time of radiologists and technicians are used.

A strategic situation analysis including defining long-term-oriented objectives should always be the first step before defining KPIs for a BSC. The selection of KPIs should be conducted in reference to set-thematic focuses and a quality evaluation that also takes into account the survey effort and consequent practical feasibility for KPIs. An important stipulation when establishing a BSC for the Jena University Hospital radiology department was that a paper-based survey of KPIs would not be used. The KPIs survey should be completely automated. The results of the BSC would be communicated through a web portal in an electronic management cockpit. That ensured that the survey for the BSC in the radiology department would not and will not require additional personnel from the management division. At Jena University Hospital, the process and financial KPIs are all generated fully automatically via database queries. The Human Resource department data, on the other hand, must still be entered manually. In our experience, these KPIs are unfortunately not regularly updated, such as the level of illness. As a result, the personal KPIs can only be meaningfully evaluated within the framework of the annual BSC. This clearly shows how important automatic digital data transmission is for a BSC in order to use it effectively as a management tool.

Overall, this example of the radiology department shows that BSC-based monitoring can also help hospitals to overcome the weaknesses of a traditionally budget-oriented reporting system and to be able to use different scorecards to meet the different requirements of a goal-oriented strategic and operational management.

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Abbreviations

• Balanced scorecard

Concision, survey effort, topicality and clarity

Key performance indicator

Magnetic resonance imaging

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Teichgräber, U., Sibbel, R., Heinrich, A. et al. Development of a balanced scorecard as a strategic performance measurement system for clinical radiology as a cost center. Insights Imaging 12 , 69 (2021). https://doi.org/10.1186/s13244-021-01009-2

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