Adaptation of the balanced scorecard model to measure performance of the departments at Dr Zainoel Abidin Regional General Hospital, Banda Aceh

The Evolution of Balanced Scorecard in Healthcare: A Systematic Review of Its Design, Implementation, Use, and Review

During the last few years, the interest in performance measurement increased within the healthcare sector. Due to the COVID-19 pandemic, healthcare systems needed to boost performance measurement systems to become more resilient and improve their capability in monitoring key performance indicators. Since the 1990s, the Balanced Scorecard (BSC) model has been widely used among private and public organizations as it is the most adopted model to measure performance. The current paper aims at understanding the evolution of BSC in healthcare. The systematic literature review has been carried out by searching keywords according to PRISMA guidelines. By analyzing papers through one classification of BSC adoption phases, the results reveal that studies focused mainly on the BSC design process, rather than BSC implementation, use, or review. However, there is no agreement about the perspectives to be adopted in healthcare. Concerning BSC implementation and use, on one side especially leadership, culture and communication enable the BSC implementation. On the other side, monitoring and strategic decision-making are the most widespread objectives for using BSC. Concerning BSC review, however, the paper highlights a need for additional research. Finally, the paper provides further research opportunities concerning the phases suitable for implementing a BSC in healthcare.

The dynamic use of a balanced scorecard in an Italian public hospital

Purpose

This paper aims to analyse the dynamic use of the balanced scorecard (BSC) in an Italian public hospital.

Design/Methodology/Approach

A longitudinal case study was conducted at an Italian public teaching hospital over a period of 5 years. The emergence of dynamic use of BSC was traced over a different combination of social, political, economic and organizational realities. A deeper understanding of these realities requires the adoption of a holistic approach to BSC use. Henri's types of system use (i.e., monitoring, attention focussing, strategic decision‐making and legitimizing) frame this approach in a more concrete manner.

Findings

This study adds to the debate on whether BSC is used for aspects other than monitoring in public contexts. The case study offers the first example of a legitimizing use of the system and a first longitudinal case study that traces a dynamic use of BSC: the use evolves from monitoring and attention focussing to monitoring and legitimization. Norms, political parties and top managers play a determining role in this process.

Originality/Value

Through a longitudinal approach, this study presents how BSC can be a dynamic tool steered by legitimacy pressures. The longitudinal study explores how social, political, economic and organizational context shape the implementation and the revision of BSC affecting the use of the tool by top managers. The browse of this dynamism is supported by Henri's type of use along with an in‐depth analysis of the BSC literature evolution in terms of its ‘static, dynamic and expected’ use.

Performance management systems, such as balanced scorecard (BSC), should be understood in a holistic view, namely taking into account the interdependency between the design, the implementation, and the use of the systems and the interdependency between different systems operating at the same time in the same organization.

How managers use BSC in hospitals changes over time.

At an organizational level, a BSC could provide justification of actions and decisions as well as monitoring results, supporting strategic decision‐making processes and focussing attention on priorities.

BSC is a pivotal lever that can be governed by hospital managers as a strategic management tool for facing legitimacy pressures.

Scoring the financial distress and the financial statement fraud of Garuda Indonesia with «DDCC» as the financial solutions

Purpose

PT Garuda Indonesia (GIAA) Persero Tbk is the one only pride airline of Indonesian sovereignty. Although the bird achieved abundant international awards and certifications, the bird is dying and needs a remedy immediately. The frequent annual turnover of board executives did not make impact to the financial performance; this seems to be tip of the iceberg, peculiar with the number of restatement over the past decade. Therefore, this paper aims to address the issue through the function of five red flags model which known as Altman Z-score, Sprigate S-score, Grover G-score, Beneish M-score and Dechow F-score.

Design/methodology/approach

This is exploratory study of univariate analysis using financial distress and fraudulent financial statement approach, while the type of data is secondary taken from Indonesia Stock Exchange during 12 years observation from 2007 to 2018.

Findings

Altman, Springate and Grover produce strong indication of GIAA’s financial distress; all models score the same distress indication by 14 times. All distress models agreed that only 2011 and 2012 classify to the safe zone when GIAA performed the corporate actions. Beneish scores fraud indication by eight times. Dechow scores slightly higher by nine times. The number of fraud predictions in this research are in line with the number of restatement, which proves the assumption that restatement can be used as a signal of the financial statement fraud. When GIAA categorized in safe zone, both Beneish and Dechow score no to fraud, this indicates the fraud occurence during health period is lower.

Research limitations/implications

The motivation behind the financial statement fraud is not discuss through this research but from the primary theory of the fraud triangle. Financial distress possesses strong relationship with pressure factor; therefore, exit from financial crisis is one of the best solution to mitigate the financial statement fraud.

Practical implications

The average of Beneish score is −2,26, slightly above the manipulator threshold which is −2,22. This must be marked as an ample conjecture of GIAA’s fraud inclination and been a highlight for the auditor both internal and external when performing control testing, attestation and other assurance services.

Social implications

All models in this study can apply to any other corporate issues, especially for evaluating the government company who has loosen the public trust recently in Indonesia such as PT Asuransi Jiwasraya and PT Asabri. Moreover, the pandemic COVID-19 has brought the world to the new unprecedented risk, especially the economic turmoil which lead the possibilities of corporate distress and fraud. By applying these scores, public might have tools as pre-elemenary assessment to serve a decision where to put trust in a company.

Originality/value

This paper reveals a combination from various models of financial distress and financial statement fraud in order to generate the financial solutions named « DDCC » Debt Restructuring, Debt Conversion, Capex Management and Cost Cutting.