Balanced Scorecard Awareness and the Factors of Adoption for Strategic Performance Reporting Systems in a Non-Profit Healthcare Organization: A Qualitative Study
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Authors
Gibbons, Christopher
Issue Date
2025-10
Type
Dissertation
Language
en
Keywords
Balanced Scorecard , Strategic Performance Adoption , Nonprofit Healthcare Organizations , Business, Engineering, Science, & Technological Innovation , Healthcare Innovation & Delivery
Alternative Title
Abstract
This qualitative interpretative descriptive study addressed the deficient adoption and integration of standardized performance reporting frameworks and systems, such as the Balanced Scorecard (BSC), within non-profit healthcare organizations. The purpose was to describe the levels of BSC awareness and comprehension, alongside the adoption criteria for such systems, among leadership and management at a multistate non-profit U.S. healthcare system. The research was guided by an integrated conceptual framework combining diffusion of innovations theory, institutional theory, and resource-based view theory. A qualitative interpretative descriptive methodology was employed, using a multiple data sources design to collect data from 36 healthcare leaders and managers via semi-structured interviews and open-ended questionnaires. Thematic analysis of the data revealed a significant gap in strategic management knowledge, with 58% of participants reporting unfamiliarity with the BSC framework. This lack of awareness was contrasted by the finding that 86% of participants had extensive experience with various alternative, often fragmented, strategic tools. BSC comprehension was highly stratified by organizational role; 75% of upper management demonstrated understanding, compared to only 7% of frontline managers, indicating a severe disconnect in knowledge transfer. Key adoption criteria identified by participants included user-friendliness, demonstrated value, alignment with organizational goals, and comprehensive training. The most significant barriers to implementation were resistance to change, insufficient time and resources, and the prevalence of hierarchical, top-down decision-making processes that exclude implementers. The study concludes that the underutilization of comprehensive strategic systems in the non-profit healthcare sector stems not from resistance to measurement itself, but from critical challenges in organizational knowledge dissemination, a lack of inclusive engagement in decision-making, and inadequate implementation support. This research offers actionable recommendations for practice focused on education, leveraging existing tool usage, and fostering inclusive governance to improve the adoption and effective use of strategic performance reporting systems in healthcare.