[The use of the balanced scorecard and the budget in the strategic management of public hospitals].

To analyze the relationship between hospital managers' characteristics and the use of the balanced scorecard and the budget. A further aim was to analyze how these two techniques influence strategic goals aimed at cost reduction and enhancing service flexibility. Data were collected through a questionnaire sent to 884 members of top management teams in 218 public hospitals in Spain. The response rate was 53.51% with 473 useful questionnaires. Structural equation techniques were used to validate the metric scales and the model used. Younger managers and less tenured managers were more likely to use the balanced scorecard than the budget. Diversity in the top management team was related to the use of distinct management control techniques. The use of the balanced scorecard was positively associated with the implementation of healthcare strategies focused on enhancing service flexibility and reducing healthcare cost. The adoption of management control systems is not only a function of the outcome of a rational decision-making process and institutional pressures but also crucially depends on the characteristics of the individuals ultimately responsible for such decisions. The use of the balanced scorecard facilitates hospitals' implementation of plans with multiple strategic goals.

Naranjo Gil D 《-》

Strategic performance in hospitals: the use of the balanced scorecard by nurse managers.

Naranjo-Gil D 《-》

How CEOs use management information systems for strategy implementation in hospitals.

Naranjo-Gil D ，Hartmann F 《HEALTH POLICY》

[The Balanced Scorecard as a management tool in a public health organization].

Villalbí JR ，Casas C ，Borrell C ，Duran J ，Artazcoz L ，Camprubí E ，Rodríguez-Montuquín P ，Armengol JM ... -  《Gaceta Sanitaria》

[Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation].

To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation. Qualitative study (case study) based on grounded theory performed between January and June 2014. Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain. UGCAP managers and Health Area (CEO) managers. Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes. Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation. This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs.

Ramón-Jerónimo JM ，Flórez-López R ，Domínguez-Lario N 《-》