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

Objective: 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. Methods: 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. Results: 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. Conclusions: 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. (C) 2009 SESPAS. Published by Elsevier Espana, S.L. All rights reserved.