فهرست مطالب mohamad ali shariat

Parallel to the progress of services, organizational complexity levels in health care centers (HCCs) have increased. The influential factors in this regard include the variety of services, the non-uniformity of the centers’ management conditions, and the rising expectations from the health system. Therefore, considering many factors influenced and effective, improvement of health services requires development of a systematic approach to evaluate their efficiency and management system. The aim of this study was to develop a balanced scorecard (BSC) model suitable for HCCs using a hybrid approach that combines the Fuzzy Delphi and DNAP techniques. 

This research was a combined qualitative-quantitative study that was conducted with the aim of developing a BSC model suitable for HCCs. The statistical population consisted of 15 experts in health and medicine, who were selected based on the targeted snowball sampling. A researcher-made questionnaire and a 20×20 matrix questionnaire were used to collect the data. The questionnaire validity was calculated based on the experts’ opinions and the reliability was calculated using Cronbach’s alpha and consistency rate. The data was analyzed using Excel and MATLAB, and DNAP technique was used to determine the cause-and-effect relationship and the influence levels of the objectives. 

According to the results of the Fuzzy Delphi technique in the panel of experts, 5 viewpoints with 20 objectives of the BSC suitable for HCCs were identified and replaced the traditional viewpoints of the BSC. In addition, these results showed that the views of growth and development, intra-organizational processes, and social responsibility are considered as the influential factors due to the positive D-R values, while the views of patients and society, financial status, and performance are considered as the factors that are effective due to the negative D-R values.

The results of this study indicated that those points of view that are consistent with the goals of the HCCs should be used in the BSC in order to evaluate their performance. Also, prioritizing and determining the cause-and-effect relationship and considering the contribution of each point of view for achieving the goals of the HCCs can increase the performance.

Due to the level of complexity of healthcare organizations, many factors play a role in improving health services. Therefore, it is necessary to develop a systematic approach to evaluate their efficiency and management system.  Balanced scorecard can play a role in this field as an evaluation system by examining the cause-and-effect relationship of goals and drawing a strategy map.  Therefore, the purpose of this research was to develop a strategy map for healthcare centers with a balanced scorecard approach.

This was a qualitative and applied research conducted using mixed methods in 2019. The statistical population of the research included all health experts from medical sciences universities across the country, 15 of whom were selected based on a targeted snowball sampling. First, through the review of texts and articles related to the literature on the subject with a general search in foreign and domestic electronic databases, a list of balanced scorecard views and the goals related to health and treatment centers of comprehensive health service centers was identified. After that, through a researcher-made questionnaire, by asking experts their opinions using fuzzy Delphi method in 2 steps, the views and goals related to comprehensive health service centers were identified. Then, through the relationships of improved network analysis process technique based on DEMETEL, in 4 steps by Excel 2016 and Matlab 2014 software, the relationships between them were examined. Finally, the effect of goals and views on each other was determined, and a strategy map was drawn.

In this research, social responsibility, as a new perspective and the attitudes of patients and society, financial status and performance improvement, growth and development, and internal processes, replaced the main perspectives of the balanced scorecard, and social responsibility was designated as a new perspective. By examining the relationship between them, the perspectives of growth and development, intra-organizational processes, social responsibility, and other views were found to be effective.

Considering the complexity of the activities regarding comprehensive health service centers, replacing the views appropriate to the comprehensive health service centers with the main views provided by Kaplan and Norton (2004) can obtain the best results regarding the goals and strategy. Based on the cause-effect relationship of views, strengthening views and effective goals creates value for effective goals. Investing on influential views and goals will empower and promote the development of balance between income and expense, and the optimal use of resources will improve the views of society and patients and the quality of services, which is the main goal of comprehensive health service centers.