The balanced scorecard as a strategic management tool in urban medical groups in China: an experimental study

This paper aims to integrate the balanced scorecard (BSC) into the medical service quality management of urban medical groups (UMGs), verify its feasibility and enhance resource allocation and system efficiency in addressing challenges like fragmented resources and poor coordination in China's urban medical service systems.

A retrospective study was conducted, in which a BSC-based strategic management model (using BSC as an improvement tool strategy) was constructed in a Zhejiang UMG from 2021 to 2024. The following four core dimensions were selected based on BSC theory and UMGs' operational needs. Financial: focused on resource allocation efficiency including medical revenue and outpatient as well as inpatient costs to ensure sustainable operations. Customer: targeted patient accessibility and satisfaction including county visit rate and chronic disease management to align with hierarchical care policies. Internal processes: measured service capacity including number of cases handled by branches to reflect grassroots capability upgrades. Learning and growth: tracked technical diffusion including new technologies introduced to branches and workforce development to strengthen long-term competitiveness.

Significant improvements were observed in key indicators: county visit rate rose by 36.35% (p < 0.001), diabetes management rate increased by 13.79% (p < 0.001), new technologies in branches grew by 66.67% and branch hospitals reduced outpatient (-20.68%) and inpatient costs (-23.96%). However, head hospital outpatient costs rose by 14.36% and hypertension management showed no significant change (p = 0.145).

This study's rigor is anchored in its BSC-driven key performance indicators and longitudinal design, but several limitations. First, the exclusive focus on quantitative metrics neglects qualitative dimensions, such as patient experience or staff morale, which are critical for holistic evaluation. Second, the absence of cost-effectiveness analysis limits understanding of resource utility. Third, the short observation period (three years) may not capture long-term impacts of BSC implementation, such as generational shifts in healthcare-seeking behavior. Fourth, the study's focus on UMGs may limit its generalizability to rural or underserved areas with distinct healthcare infrastructure and population needs.

It is the first integration of BSC into UMGs' medical service quality management, demonstrating BSC's effectiveness in driving balanced growth via enhanced grassroots accessibility and technical integration. It offers a data-driven strategic model for UMGs to improve resource allocation and achieve equitable healthcare.

This study fills the research gap in applying multi-dimensional performance management tools to China's context-specific UMGs. It extends BSC's application scope from individual hospitals or general healthcare institutions to integrated healthcare systems. By validating BSC's effectiveness in driving balanced growth through grassroots accessibility enhancement and technical integration via longitudinal empirical data, the research enriches the academic literature on BSC in healthcare management and provides a novel theoretical-practical framework for similar integrated healthcare reform in middle-income countries.