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A Balanced Scorecard Approach in Assessing IT Value in Healthcare Sector: An Empirical Examination

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Abstract

Healthcare sector indicates human-based and knowledge-intensive property. Massive IT investments are necessary to maintain competitiveness in this sector. The justification of IT investments is the major concern of senior management. Empirical studies examining IT value have found inconclusive results with little or no improvement in productivity. Little research has been conducted in healthcare sector. The balanced scorecard (BSC) strikes a balance between financial and non-financial measure and has been applied in evaluating organization-based performance. Moreover, healthcare organizations often consider their performance goal at customer satisfaction in addition to financial performance. This research thus proposed a new hierarchical structure for the BSC with placing both finance and customer at the top, internal process at the next, and learning and growth at the bottom. Empirical examination has found the importance of the new BSC structure in assessing IT investments. Learning and growth plays the initial driver for reaching both customer and financial performance through the mediator of internal process. This can provide deep insight into effectively managing IT resources in the hospitals.

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References

  1. Au, Y. A., and Kauffman, R. J., The economics of mobile payments: understanding stakeholder issues for an emerging financial technology application. Electronic Commerce Research and Applications 7(2):141–164, 2008.

    Article  Google Scholar 

  2. Basu, A., and Blanning, R. W., Synthesis and decomposition of processes in organizations. Information Systems Research 14(4):337–355, 2003.

    Article  Google Scholar 

  3. Bharadwaj, A. A., Resource-based perspective on information technology capability and firm performance: an empirical investigation. MIS Quarterly 24(1):169–196, 2000.

    Article  Google Scholar 

  4. Brynjolfsson, E., and Hitt, L., Beyond computation: information technology. Organizational Transformation and Business Performance 14(4):23–48, 2000.

    Google Scholar 

  5. Brynjolfsson, E., and Hitt, L., Computing productivity: firm-level evidence. Review of Economic and Statistics 85(4):793–808, 2003.

    Article  Google Scholar 

  6. Bremser, W., and Chung, Q. B., A framework for performance measurement in the e-business environment. Electronic Commerce Research and Applications 4(4):395–412, 2005.

    Article  Google Scholar 

  7. Bush, M., Lederer, A. L., Li, X., Palmisano, J., and Rao, S., The alignment of information systems with organizational objectives and strategies in health care. International Journal of Medical Informatics 78(7):446–456, 2009.

    Article  Google Scholar 

  8. Chan, Y. E., IT value: the great divide between qualitative and quantitative and individual and organizational measures. Journal of Management Information Systems 16(4):225–261, 2000.

    Google Scholar 

  9. Chen, C.-Y., Chang, R.-E., Hung, M.-C., and Lin, M.-H., Assessing the quality of a web-based learning system for nurse. Journal of Medical Systems 33:317–325, 2009.

    Article  Google Scholar 

  10. Chow, C., Ganulin, D., Haddad, K., and Williamson, J., The balances scorecard: a potent tool for energizing and focusing healthcare organization management. Journal of Healthcare Management 43(3):263–280, 1998.

    Google Scholar 

  11. Chow, C., and Goh, M., Framework for evaluating performance and quality improvement in hospitals. Managing Service Quality 12(1):54–66, 2002.

    Article  Google Scholar 

  12. Curtright, J. W., Stolp-Smith, S. C., and Edell, E., Strategic performance management: development of a performance measurement system at the Mayo clinic. Journal of Healthcare Management 45(1):58–68, 2000.

    Google Scholar 

  13. Davern, M., and Kauffman, R., Discovering potential and realizing value from information technology investments. Journal of Management Information Systems 16(4):121–143, 2000.

    Google Scholar 

  14. Devaraj, S., and Kohli, R., Information technology payoff in the health-care industry: a longitudinal study. Journal of Management Information Systems 16(4):41–67, 2000.

    Google Scholar 

  15. Devaraj, S., and Kohli, R., Performance impacts of information technology: is actual usage the missing link? Management Science 49(3):273–289, 2003.

    Article  Google Scholar 

  16. Dillman, D. A., Mail and Internet surveys: the tailored design method, 2nd edition. Wiley, New York, 2000.

    Google Scholar 

  17. Fornell, C., and Larcker, D. F., Structural equation models with unobservable variables and measurement error: algebra and statistics. Journal of Marketing Research 18(3):382–388, 1981.

    Article  Google Scholar 

  18. Ghalayini, A. M., and Noble, J. S., The changing basis of performance measurement. International Journal of Operations & Production Management 16(8):63–80, 1996.

    Article  Google Scholar 

  19. Gordon, D., Chapman, R., Kunov, H., Dolan, A., and Carte, M., Hospital management decision support: a balanced scorecard approach. Medical Information 9(1):453–456, 1998.

    Google Scholar 

  20. Gordon, D., Chapman, R., Kunov, H., Dolan, A., and Carte, M., A strategic information system to facilitate the use of performance indicators in hospitals. Health Services Management Research 11(2):80–91, 1998.

    Google Scholar 

  21. Griffith, J. R., and King, J. G., Championship management for healthcare organization. Journal of Healthcare Management 45(1):17–31, 2000.

    Google Scholar 

  22. Grembergen, W. V., Saull, R., and Haes, S. D., Linking the IT balanced scorecard to the business objectives at a major Canadian financial group. Journal of Information Technology Cases and Application 5(1):23–45, 2003.

    Google Scholar 

  23. Gumbus, A., Lyons, B., and Bellhouse, D. E., Journey to destination 2005. Strategic Finance 84(2):46–50, 2002.

    Google Scholar 

  24. Gurd, B., and Gao, T., Lives in the balance: an analysis of the balanced scorecard (BSC) in healthcare organizations. International Journal of Productivity and Performance Management 57(1):6–21, 2008.

    Article  Google Scholar 

  25. Henry, J. W., and Stone, R. W., A structural equation model of end-user satisfaction with a computer-based medical information system. Information Resource Management Journal 7(3):21–33, 1994.

    Google Scholar 

  26. Heo, J., and Han, I., Performance measure of information systems (IS) in evolving computing environments: an empirical investigation. Information Management 40(4):243–256, 2003.

    Article  Google Scholar 

  27. Hoque, Z., and James, W., Linking balanced scorecard measures to size and market factors-impact on organizational performance. Journal of Management Accounting Research 12:1–17, 2000.

    Article  Google Scholar 

  28. Huang, J., Jiang, X., and Tang, Q., An e-commerce performance assessment model: its development and an initial test on e-commerce applications in the retail sector of China. Information Management 46(2):100–108, 2009.

    Article  Google Scholar 

  29. Inamdar, N., Kaplan, R., and Reynolds, K., Applying the balanced scorecard in healthcare provider organizations. Journal of Healthcare Management 47(3):179–196, 2002.

    Google Scholar 

  30. Kaplan, R. S., and Norton, D. P., The balanced scorecard-measures that drive performance. Harvard Business Review 70(1):71–79, 1992.

    Google Scholar 

  31. Kaplan, R. S., and Norton, D. P., Linking the balanced scorecard to strategy. California Management Review 39(1):53–79, 1996.

    Article  Google Scholar 

  32. Kaplan, R. S., and Norton, D. P., Using the balanced scorecard as a strategic management system. Harvard Business Review 74(1):75–85, 1996.

    Google Scholar 

  33. Kaplan, R. S., and Norton, D. P., Transforming the balanced scorecard from performance measurement to strategic management: part I. Accounting Horizons 15(1):87–104, 2001.

    Article  MATH  Google Scholar 

  34. Kaplan, R. S., and Norton, D. P., Measuring the strategic readiness of intangible assets. Harvard Business Review 82(2):52–63, 2004.

    Google Scholar 

  35. Kaplan, R. S., and Norton, D. P., The strategy map: guide to aligning intangible assets. Strategy and Leadership 32(5):10–17, 2004.

    Article  Google Scholar 

  36. Lee, H., and Choi, B., Knowledge management enablers, processes, and organizational performance: an integrative view and empirical examination. Journal of Management Information Systems 20(1):179–22, 2003.

    Google Scholar 

  37. Libby, T., Salterio, S. E., and Webb, A., The balanced scorecard: the effects of assurance and process accountability on managerial judgment. The Accounting Review 79(4):1075–1094, 2004.

    Article  Google Scholar 

  38. Lovaglio, P. G., Model building and estimation strategies for implementing the balanced scorecard in health sector. Quality and Quantity 45:199–212, 2011.

    Article  Google Scholar 

  39. Luttman, R. J., Next generation quality, part 2: balanced scorecards and organizational improvement. Topics in Health Information Management 19(2):22–29, 1998.

    Google Scholar 

  40. Maenpaa, T., Suominen, T., Asikainen, P., Maass, M., and Rostila, I., The outcomes of regional healthcare information systems in health care: A review of the research literature. International Journal of Medical Informatics 78(11):757–771, 2009.

    Article  Google Scholar 

  41. Martinsons, M., Davison, R., and Tse, D., The balanced scorecard: a foundation for the strategic management of information systems. Decision Support Systems 25(1):71–88, 1999.

    Article  Google Scholar 

  42. McFadden, K. L., Stock, G. N., and Gowen, C. R., Exploring strategies for reducing hospital errors. Journal of Healthcare Management 51(2):123–135, 2006.

    Google Scholar 

  43. Melville, N., Krarmer, K., and Gurbaxani, V., Review: information technology and organizational performance: an integrative model of IT business value. MIS Quarterly 28(2):283–322, 2004.

    Google Scholar 

  44. Menachemi, N., Burke, D., and Brooks, R. G., Adoption factors associated with patient safety-related information technology. Journal for Healthcare Quality 26(6):39–44, 2004.

    Article  Google Scholar 

  45. Menon, N. M., and Lee, B., Cost control and production performance enhancement by IT investment and regulation changes: evidence from the healthcare industry. Decision Support Systems 30(2):153–169, 2000.

    Article  Google Scholar 

  46. Nardon, F. B., and Moura, L. A., Knowledge sharing and information integration in healthcare using ontology and deductive databases. Medical Information 11(1):62–66, 2004.

    Google Scholar 

  47. O’Connor, N. G., and Martinsons, M. G., Management of information systems: insights from accounting research. Information Management 43(8):1014–1024, 2006.

    Article  Google Scholar 

  48. Oliveira, J., The balanced scorecard: an integrative approach to performance evaluation. Healthcare Financial Management 55(5):42–46, 2001.

    Google Scholar 

  49. Pineno, C. J., The balanced scorecard: an incremental approach to health care management. Journal of Health Care Finance 28(4):69–80, 2002.

    Google Scholar 

  50. Plant, R., Willcocks, L., and Olson, N., Measuring e-business performance: towards a revised balanced scorecard approach. Information Systems and e-Business Management 1(3):265–281, 2003.

    Google Scholar 

  51. Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., and Podsakoff, N. P., Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology 88:879–903, 2003.

    Article  Google Scholar 

  52. Potthoff, S. O., Ison, D., Thompson, N., and Kissner, M., Long-term care management: a balanced performance measurement system. Journal of Strategic Performance Measurement 31:16–22, 1999.

    Google Scholar 

  53. Rahimi, B., and Vimarlund, V., Methods to evaluate health information systems in healthcare sector setting: A literature review. Journal of Medical Systems 31:16–29, 2007.

    Article  Google Scholar 

  54. Rai, A., Patnayakuni, R., and Patnayakuni, N., Technology investment and business performance. Communications of the ACM 40(7):89–97, 1997.

    Article  Google Scholar 

  55. Rai, A., Patnayakuni, R., and Seth, N., Firm performance impacts of digitally-enabled supply chain integration capabilities. MIS Quarterly 30(2):225–246, 2006.

    Google Scholar 

  56. Segars, A. H., and Grover, V., The industry-level impact of information technology: an empirical analysis of three industries. Decision Sciences 26(3):337–368, 1995.

    Article  Google Scholar 

  57. Seddon, P. B., Graeser, V., and Willcocks, L., Measuring organizational IS effectiveness: an overview and update of senior management perspective. The Data Base for Advances in Information Systems 33(2):11–28, 2002.

    Article  Google Scholar 

  58. Straub, D. W., and Watson, R. T., Transformational issues in researching IS and net-enabled organizations. Information Systems Research 12(4):337–345, 2001.

    Article  Google Scholar 

  59. Tanriverdi, H., Information technology relatedness, knowledge management capability, and performance of multibusiness firms. MIS Quarterly 29(2):11–334, 2005.

    Google Scholar 

  60. Taylor, T. B., Information management in the emergency department. Emergency Medicine Clinics of North America 22(1):241–57, 2004.

    Article  Google Scholar 

  61. Teng, J. T. C., Grover, V., and Fiedler, K. D., Business process reengineering: charting a strategic path for the information age. California Management Review 36(3):9–31, 1994.

    Article  Google Scholar 

  62. Tsiknakis, M., and Kouroubali, A., Organizational factors affecting successful adoption of innovative eHealth services: A case study employing the FITT framework. International Journal of Medical Informatics 78(1):39–52, 2009.

    Article  Google Scholar 

  63. Voelker, K. E., Rakich, J. S., and Richard, F. G., The balanced scorecard in healthcare organizations: a performance measurement and strategic planning methodology. Hospital Topics 79(3):13–24, 2001.

    Article  Google Scholar 

  64. Vogel, L. H., Finding value from IT investments: exploring the elusive ROI in healthcare. Journal of Healthcare Information Management 17(4):20–28, 2003.

    Google Scholar 

  65. Wicks, A. M., and Clair, L. S., Competing value in healthcare: balancing the (un)balanced scorecard. Journal of Healthcare Management 52(5):309–324, 2007.

    Google Scholar 

  66. Wu, I.-L., A model for implementing BPR based on strategic perspectives: an empirical study. Information Management 39(4):313–324, 2002.

    Article  Google Scholar 

  67. Wu, I.-L., and Chen, J.-L., A hybrid performance measure system for e-business investments in high-tech manufacturing: an empirical study. Information Management 43(3):364–377, 2006.

    Article  Google Scholar 

  68. Wu, I.-L., and Chang, C.-H., Using the balanced scorecard in assessing the performance of e-SCM diffusion: a multi-stage perspective. Decision Support Systems 52:474–485, 2012.

    Article  Google Scholar 

  69. Yeniyurt, S. A., Literature review and integrative performance measurement framework for multinational companies. Marketing Intelligence & Planning 21(3):134–142, 2003.

    Article  Google Scholar 

  70. Yeung, A. K., Ulrich, D. O., Nason, S. W., and Glinow, M. A., Organizational learning capability. Oxford University Press, New York, 1999.

    Google Scholar 

  71. Zelman, W. N., Pink, G. H., and Matthias, C. B., Use of the balanced scorecard in healthcare. Journal of Healthcare Finance 29(4):1–66, 2003.

    Google Scholar 

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Acknowledgement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. National Chung Cheng University, Chia-Yi, Taiwan, Republic of China

    Ing-Long Wu & Yi-Zu Kuo

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  1. Ing-Long Wu
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Correspondence to Ing-Long Wu.

Appendix

Appendix

Basic information

  1. (1)

    Hospital type

  2. (2)

    Annual revenue (NT$ millions)

  3. (3)

    Number of employees (Persons)

  4. (4)

    Working experience

  5. (5)

    Education level

  6. (6)

    Gender

  7. (7)

    Age

  8. (8)

    Position

IT investments

  1. (1)

    There are massive investments in computer hardware in my hospital.

  2. (2)

    There are massive investments in computer software in my hospital.

  3. (3)

    There are massive investments in IT personnel in my hospital.

BSC performance

  1. 1.

    Financial perspective

    1. (1)

      Use of IT can help improve utilization of medical equipments and facilities.

    2. (2)

      Use of IT can help increase occupancy rate of beds.

    3. (3)

      Use of IT can help increase turnover rate of beds.

    4. (4)

      Use of IT can help increase new revenue from self-payment medical services.

    5. (5)

      Use of IT can help increase new revenue from new customer market.

    6. (6)

      Use of IT can help increase new revenue from community service.

    7. (7)

      Use of IT can help increase return on investment.

    8. (8)

      Use of IT can help increase sale revenue.

    9. (9)

      Use of IT can help increase profit margins.

    10. (10)

      Use of IT can help increase market share.

  2. 2.

    Customer perspective

    1. (11)

      Use of IT can help improve availability of medical service.

    2. (12)

      Use of IT can help improve accessibility of medical service.

    3. (13)

      Use of IT can help improve quality of medical service.

    4. (14)

      Use of IT can help improve patient satisfaction.

    5. (15)

      Use of IT can help improve medical staff satisfaction.

    6. (16)

      Use of IT can help improve administrative staff satisfaction.

    7. (17)

      Use of IT can help improve payer satisfaction.

    8. (18)

      Use of IT can help promote hospital image and reputation.

    9. (19)

      Use of IT can help promote hospital rank in customer survey.

    10. (20)

      Use of IT can help promote hospital recognition of medical service.

  3. 3.

    Internal process perspective

    1. (21)

      Use of IT can help improve administrative service process.

    2. (22)

      Use of IT can help improve healthcare service process.

    3. (23)

      Use of IT can help improve after-medical-care service process.

    4. (24)

      Use of IT can help avoid medical errors or incidents.

    5. (25)

      Use of IT can help identify more innovative opportunities for hospital.

    6. (26)

      Use of IT can help develop innovative medical service.

    7. (27)

      Use of IT can help design innovative administrative service.

  4. 4.

    Learning and growth perspective

    1. (28)

      Use of IT can help improve skill of employees.

    2. (29)

      Use of IT can help improve talent of employees.

    3. (30)

      Use of IT can help improve know-how capabilities of employees.

    4. (31)

      Use of IT can help provide more opportunities for training of employees.

    5. (32)

      Use of IT can help improve knowledge sharing of employees.

    6. (33)

      Use of IT can help improve awareness of shared vision, objectives, and value.

    7. (34)

      Use of IT can help improve availability of qualified leaders.

    8. (35)

      Use of IT can help improve alignment of goal and incentives with strategy.

    9. (36)

      Use of IT can help improve quality of information.

    10. (37)

      Use of IT can help improve knowledge management capabilities.

    11. (38)

      Use of IT can help improve accessibility of various information.

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Wu, IL., Kuo, YZ. A Balanced Scorecard Approach in Assessing IT Value in Healthcare Sector: An Empirical Examination. J Med Syst 36, 3583–3596 (2012). https://doi.org/10.1007/s10916-012-9834-2

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