Post on 10-Mar-2018
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 1 of 16
Journal of Business and Human Resource Management Received: Nov 22, 2015, Accepted: Jan 12, 2016, Published: Jan 15, 2016
J Bus Hum Resour Manag, Volume 2, Issue 1
http://crescopublications.org/pdf/jbhrm/JBHRM-2-005.pdf
Article Number: JBHRM-2-005
Research Article Open Access
Designing a Developed Balanced Score-card Model to Assess Hospital
Performance Using the EFQM, JCI Accreditation Standards and Clinical
Governance
Fatemeh Semnani* and
Rouhangiz Asadi
Hospital Management of Research Hospital, Iran University Medical of Sciences, Tehran, Iran
*Corresponding Authors: 1. Fatemeh Semnani, Hospital Management of Research Hospital, Iran University Medical of
Sciences, Tehran, Iran; Tel: 00982188644485; Fax: 00982188644479; E-mail: Shirinsemnani@yahoo.com
2. Rouhangiz Asadi, Hospital Management of Research Hospital, Iran University Medical of Sciences, Tehran, Iran; Tel: 0098 21
88644485; Fax: 0098 21 88644479; E-mail: r.asadi@modares.ac.ir
Citation: Fatemeh Semnani and
Rouhangiz Asadi (2016) Designing a Developed Balanced Score-card Model to Assess Hospital
Performance Using the EFQM, JCI Accreditation Standards and Clinical Governance. J Bus Hum Resour Manag 1: 005.
Copyright: © 2016 Fatemeh Semnani and Rouhangiz Asadi. This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted Access, usage, distribution, and reproduction in any medium,
provided the original author and source are credited.
Abstract
It is vital in today‟s competitive world to present high-quality health services with appropriate costs and on-time
delivery in order to achieve competitive advantages for hospitals. To this end, assessment of hospital performance and
continuous improvement of the performance play key roles. Many standards and systems are used in hospitals for
assessing the hospital performance, none of which covers all hospital areas alone. Therefore, in Hasheminejad
hospital, a new and complete model covering all areas was designed and utilized using JCI accreditation standards,
clinical governance and EFQM model of organization sublimity and the combination of these standards with balanced
score card (BSC) model dimensions. Based on Radar logic, continuous improvement has occurred in hospital
performance. The designed model was administered in Hasheminejad Hospital for 4 years, and the results related to
the consecutive years were analyzed and compared. The model administration for 4 years in Hasheminejad Hospital
indicated continuous improvement of hospital performance and the success of the presented model.
Keywords: Performance assessment; Operational standards; System of performance assessment; Continuous
improvement; Balanced score card.
Introduction
Healthcare is not only the fastest growing service industry,
both in the developed and developing countries, but also
impacts the well-being of people. For this reason, healthcare
is receiving much attention around the world [1]. As quality
of care and service is a top priority, the health care
organizations are continuously making efforts for improving
quality of services and increasing business performance.
Some of today‟s primary discussion topics in health care are
cost management, empowerment of patients, deregulation,
and competition between health care providers [2]. The goal
of the health care organizations is to achieve the highest
quality of care possible with the resources that are available,
even with limited medical equipment, human resources,
finances, and others [2, 3]. During recent years, health
system officials in different countries of the world have used
various methods to increase the quality and security of
health services, and manage them optimally. In a broad look,
they can be investigated within two main groups:
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 2 of 16
1. Models that increase organization‟s commitment to
quality promotion by extra-organizational assessment based
on quality,
2. Methods that help manage the quality inside
organizations.
Among these, accreditation from the first group, and clinical
governance and security pro from the second group enjoyed
a special position in the health section.
This is because the security and patient-based discourses are
paid attention beside service quality promotion and,
organization commitment is emphasized for the purpose of
administering high servicing standards. Therefore, the model
presented in this research tries to provide easy and cool
conditions for hospitals to increase its ability in presenting
secure, and qualitative, services that are based on update and
native evidence via concurrent and coordinated utilization of
all management models and quality guarantee and to get
prepared for extra-organizational assessment based on
specified standards. Moreover, the main problem with
hospitals, especially Hasheminejad Hospital is in their
plurality of evidences and maintaining different editions of
them. A shared document may be developed several times
for a number of qualitative models, while it can be
developed just once and used in different models for several
times. Updating these documents for every model in every
time period is a difficult and time-consuming task. This
model provides the possibility that each topic be defined
once and used in all qualitative models. The models of
quality guarantee and management, accreditation, clinical
governance, EFQM and BSC, existence of strategic program
and operational programs are suggested in hospital, and in
all of these models, the existence of the goal of security and
quality promotion in strategic program is intended.
Therefore, when the hospital observes security in line with
clinical governance, it means the fulfilment of the security
section of clinical governance [4].
Literature Review
The BSC
In 1992, Dr. Robert Kaplan and Dr. David Norton
introduced the BSC as a performance measurement tool. It is
also a strategic management tool for translating an
organization‟s strategies into operational terms. The BSC is
a conceptual tool, and its four perspectives can be modified;
flexibility is part of its attraction. Accordingly, the BSC is a
performance measurement tool that can be customized for
every organization and utilized as a strategic management
framework to align an organization‟s strategies and
objectives. Implementing the BSC requires that executives:
a) develop coherent strategies in order to achieve the
organization‟s mission and b) develop a set of KPI to
monitor the organization‟s performance and strategic
alignment [5].
Many organizations use the BSC merely as a performance
measurement tool. However, it is necessary to track strategic
alignment as there is usually deviation between an
organization‟s goals and executive actions; this happens
because executive actions are affected by variable
environmental factors such as politics and economic
conditions. By defining long-term and short-term goals,
organizations will be able to measure their performance and
track their strategic alignment. It helps directors to find out
what the organization‟s current situation is, and how it is
supposed to be; subsequently they can adapt appropriate
strategies to meet deviation between the organization‟s goals
and executive actions.
BSC generations
BSC evolution can be divided into three stages known as
three BSC generations. Each generation is distinguished by
its method of utilizing performance perspectives and KPI
(Key Performance Index) to reflect an organization‟s
performance and strategies [6]. The first generation of BSC
combines financial and non-financial indicators under four
traditional perspectives: financial, customer, internal
business process, and learning and growth. The BSC‟s first
generation, also known as traditional BSC, includes KPIs
that are only proper for performance the measurement. This
generation of the BSC is relatively easy to develop and
implement [6].
The second generation of BSC emphasizes cause and effect
relationships among measures and strategic objectives. It has
become a strategic management tool that utilizes a strategy
map to reflect the linkage among measures and strategies. In
fact, there is a formal linkage of strategic management and
performance management that is emphasized by the second
generation of BSC [6].
Lawrie and Cobbold argued that the third generation of BSC
is about developing strategic control systems by
incorporating destination statements, and optionally two
perspective strategic linkage models. They used „activity‟
and „outcome‟ perspectives instead of the four traditional
perspectives [7]. Speckbacher et al. [8] defined the third
generation of BSC as the second generation of the BSC that
additionally implements the organization‟s strategies by
defining its objectives, action plans and results, and by
linking incentives to BSC measures. Miyake stated that the
third generation of BSC derives from the concept of the
strategy-focused organization [8].
BSC in the health sector
Although there was initially a low perception of the BSC
within the health sector, over the past decade, interest in the
BSC has been growing among the health service providers
around the world in both the developed and developing
countries. According to the literature, there is a diversity of
reasons for development and implementation of the BSC in
the health sector.
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 3 of 16
Major reasons are presented in Table 1, which highlights a
set of significant reasons for BSC implementation in the
health sector, from improved performance measurement and
reporting to organizational integration. In an extensive
review, Zelman et al. [9, 10] indicated that the BSC has been
introduced across all health service areas including:
Hospitals
University medical centers and health departments
Pharmaceutical care
Health insurance companies
Not only has the BSC been utilized for strategic
management at the organizational level, but it has also been
used within the health setting for assessment of health
services, improvement projects, accreditation, clinical
pathways, and performance measurement across a number
of hospitals. The first article on BSC in the health sector was
published in 1994; it argued the necessity for continuous
quality improvements in the health setting.
Table 1: Some examples of documented reasons for implementation of the balanced scorecard (BSC) in the health sector
Authors Organization Reason
Aguilera and Walker
[11]
St Vincent‟s
Private Hospital,
Australia
The BSC was initially introduced in the nursing directorate as a framework for
improving clinical governance in order to achieve better outcomes for patients and
staff. Due to the success of this trial, it was later expanded across the whole hospital.
Bloomquist and Yeager
[12]
Emory Healthcare
in Atlanta, USA
They had a structural transition from independent units (three hospitals and two faculty
practices) to an integrated healthcare system. They utilized the BSC in order to assist
in generating a unified system to reach successful transition.
Chang et al. [13] Mackay Memorial
Hospital, Taiwan
They needed to use best practice business tools to help them take a more strategic
approach that would differentiate their services and attract more business, and that
would also improve communication and collaboration between all levels of staff and
key stakeholders. In addition, their board requested an annual performance report that
would provide a more comprehensive view of the organization‟s performance in
fulfilling its mission.
Garling [14] Children‟s Health
Systems, USA
With an upcoming major capital expansion, along with a recognition that the
organization was structured by region and health practice with competing agendas and
resource demands, executives at Nemours Children‟s Health System in the USA
decided to unify the organization around „One Nemours‟. Critical to this
transformation was their adoption of the BSC to help align and strengthen the
organization.
Gottlieb [15] Faulkner Hospital,
USA
The BSC was implemented to help them have a source of reliable information on
performance. They also intended to address several major challenges including nursing
shortages, and ensuring that all patients, regardless of socioeconomic status, received
top-quality care.
Aidemark and Funck
[16]
Högland Hospital,
Sweden
The BSC was introduced as a management tool to combine financial control and
quality improvement, along with the development of clinical staff competence. It was
initially introduced in 1997 as a 2-year trial but continued because of the success of the
trial.
Marr and Creelman
[17]
The Northumbria
Healthcare NHS
Foundation, UK
They were looking for a new and powerful tool for sharpening their strategic
formulation capabilities, to ensure they continued to be a high-performing healthcare
provider.
McDonald et al. [18]
St Mary‟s/Duluth
Clinic Health
System
They utilized the BSC after finding that traditional methods of healthcare strategy
formulation (for example, extensive consultation resulting in a complex detailed
strategic plan) did not work and they needed to adopt a new approach from outside of
healthcare.
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 4 of 16
The residency hospital of Shahid Hasheminejad is the first
and the only special center of kidney disease treatment in
Iran that is more than 50 years old and supervised under
University of Medical Sciences Iran. Beside urology,
nephrology, andrology and vascular surgery services, this
center has units for substitutive kidney treatments such as
hemodialysis, peritoneal dialysis and kidney transplantation.
Over the last decade, this hospital took measures to use
models for quality promotion and performance assessment
systems to enhance its servicing in the universal class
besides providing a successful model for country-wide
benchmarking. To begin the promotion process and
movement towards sublimity, the assessment tool of EFQM
was translated and converted under the hospital, and country
wide conditions were used. As an independent organization,
it began assessing, planning and using quality systems with
no assistance nor supervision from superior organization.
The result was a considerable change that promoted all key
outcomes of the organization performance. Moreover, as a
country wide model in the health industry, it was visited by
hospital and non-hospital bodies. In parallel, the models
used and even the innovations resumed in the very center via
trial and error were used in other centers. After the initial
years and by the organizational maturity, the need to use
several promotion models and different systems as well as
the entrance of superior organizations into qualitative
assessment of hospitals (in Iran in substitution for
quantitative assessments) created new problems such as the
following:
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 5 of 16
The hospital was visited by a group of superior
organizations with several assessment models. In other
words, each health ministry assistance used one
assessed model according to defined goals and
missions, and required hospitals to respond based on
the same model. Clinical governance, security-pro
hospital, sublimity by EFQM, Iso TQM, 6 Sigma, 5s,
BSM, etc. were among these models and systems.
Some of the indices and areas suggested in these
models were common and some were different from
each other. Most of these models were common in
quality and security but mixed up the hospital in
presenting and preparing for responsibility.
An integrated and comprehensive model covering all
operational areas of hospital, financial or non-financial,
was not presented (based on the conducted given in
Table 1).
Integrated Conceptual Model based on BSC
First, the junior managers of the organization decided that
the ideal solution is the use of the best option, each model‟s
dimensions for quality promotion and models combination,
and response to superior organizations based on request type
or the requested model. Because of the expanse of each
model and its assessment checklists, it was necessary that a
number of bureaus for each model be formed by expert and
specialized staff using the relevant models and each office
are responsible for collecting its own unit‟s documents.
The documents related to financial indicators are extracted
from the documents included in the EFQM and BSC models
and national accreditation. However, there are not financial
indicators in JCI, clinical governance.
The second solution was the use of the models of the very
center and juxtaposing the indices, dimensions, and criteria
of BSC and EFQM regardless of the requests of superior
organizations. Since the organization forces were besieged
at the time of external assessments and request for document
presentation according to other models in order to change its
presentation type and documents frames immediately, this
solution did not succeed either because it consumed high
levels of energy or was costly in human terms. Therefore,
the third solution was developing a conceptual model based
on BSC that could answer all the above challenges. The
present research addressed this comprehensive and
integrated solution for hospital management. Since an
organization‟s strategic goals specified based on its
statements determine where organizations move to, it was
decided that the model used for performance assessment and
the strategic program establishment in this hospital should
be used as the basic model based on which other models will
be arranged. Therefore, because the BSM model was used in
this center since 2007, it was selected as the method for
strategic program establishment and the basis for
organization‟s performance assessment. Then, the
conceptual model of the research was considered and
suggested based on the following format:
The suggested model consisted of three levels. At the first
level, there are standards and requirements that should be
observed by all health centers, that is, JCI (at the universal
level), national accreditation (in Iran), clinical governance
(at the universal level) as well as the requirements that all
organizations, including health, servicing, productive
organizations, etc. are to observe like EFQM.
At the second level, there are operational criteria
incorporating the criteria extracted from the four dimensions
of BSM (society and servicing/customers, internal
processes, development and learning, and financial).
The third level was defined based on BSC administration
method developed at the levels of organization and all units.
This model is derived from Radar logic in the EFQM model.
In the Radar logic, the organization has to determine the
results that it wants to achieve based on the beneficiaries‟
needs and its own processes (R = Results). To achieve the
desired results at present and in the future, a collection of
appropriate approaches is planned and developed (A =
Approach). To ensure administration of appropriate
approaches, they should be deployed systematically (D =
Deployment). The deployed approaches should be assessed
and refined based on monitoring and analyzing the achieved
results and the continuous learning activities (Refinement &
A = Assessment). The results (R) were turned into necessary
standards and major criteria at level one. The approaches
and administration were translated at the second level, and
the assessment and refinement (R) were defined at the third
level.
Model Components
Accreditation
Accreditation means systematic evaluation of centers
presenting health services with specified standards
emphasizing continuous quality improvement, key role of
the patient and enhanced security for patient and the staff.
Accreditation is used for describing the quality of health
services as the basis of the relevant thoughts. It is based on
healthcare policies and understanding what is related to the
care quality besides concentration on fundamental principles
for consolidating the development of health system and
activating it [4].
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Figure 1: Conceptual Model of the Research
JCI
Joint Commission International (JCI) is an international
organization that accredits hospitals worldwide since 1998.
With regional offices in Asia-Pacific, Europe and the
Middle East, and North Africa, JCI works with ministries of
health, international health care organizations, public health
agencies, governmental agencies, and others to evaluate and
improve the quality and safety of patient care throughout
each region. JCI is uniquely positioned to adapt leading
global practices to the delivery of local care. Standards are
developed and organized around important functions
common to all health care organizations. The functional
organization of standards is now the most widely used
around the world, and has been validated by scientific study,
testing, and application.
The EFQM model
The EFQM Excellence Model allows people to understand
the cause and effect relationships between what their
organization does and the results it achieves.
The model comprises of a set of three integrated
components:
The fundamental concepts of excellence
The fundamental concepts define the underlying principles
that form the foundation for achieving sustainable
excellence in any organization.
The criteria
The Criteria provide a framework to help organizations to
convert the Fundamental Concepts and RADAR thinking
into practice.
The RADAR
RADAR is a simple but powerful tool for driving systematic
improvement in all areas of the organization.
The beauty of the model is that it can be applied to any
organization, regardless of size, sector or maturity. It is non-
prescriptive and takes into account a number of different
concepts. It provides a common language that enables our
members to effectively share their knowledge and
experience, both inside and outside their own organization.
The Fundamental Concepts of Excellence outline the
foundation for achieving sustainable excellence in any
organization. They can be used as the basis to describe the
attributes of an excellent organizational culture. They also
serve as a common language for top management.
The RADAR logic is a dynamic assessment framework and
powerful management tool that provides a structured
approach to questioning the performance of an organization.
National
accreditation
Assess and improve the performance of
hospital
Hospital performance evaluation based on BSC
Finance
perspective
Learning and training
perspective
Internal processes Society and the
environment
EFQM JCI Clinical
Governance
Standards and basic models
Fits models with perspective of BSC
Implementation of BSC
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At the highest level, the RADAR logic states that an
organization should:
Determine the results it is aiming to achieve as part of
its strategy.
Plan and develop an integrated set of sound approaches
to deliver the required results both now and in the
future.
Deploy the approaches in a systematic way to ensure
implementation.
Assess and Refine the deployed approaches based on
monitoring and analysis of the results achieved and on-
going learning activities.
Clinical Governance
Clinical governance is a systematic approach to maintaining
and improving the quality of patient care within a health
system (NHS). Clinical governance became important in
health care after the Bristol heart scandal in 1995, during
which an anesthetist, Dr. Stephen Bolsin, exposed the high
mortality rate for pediatric cardiac surgery at the Bristol
Royal Infirmary. It was originally elaborated within the
United Kingdom National Health Service (NHS), and its
most widely cited formal definition describes it as:
a framework through which NHS organizations are
accountable for continually improving the quality of their
services and safeguarding high standards of care by creating
an environment in which excellence in clinical care will
flourish key features of clinical governance, which will
require clinicians in healthcare trusts and primary care
groups to lead the development of systems for local quality
assurance and quality improvement listed in the follow:
a “duty of quality”, which relates to the organization,
not just individuals within the organization;
a comprehensive strategy to be developed by each
organization, including a range of quality improvement
methods, (e.g., audit and risk management) linked
closely to professional development programs;
a named individual appointed within each provider
organization who has responsibility for improving the
quality of care;
a focus on clinical leadership, though with greater
external accountability A focus on processes of care,
including clinical decision making, and on concepts of
appropriateness, clinical effectiveness, and evidence-
based care
Set in the context of a nationally coordinated program
of clinical guideline development including service
standards for priority areas.
Clinical governance is composed of at least the following
elements:
Education and training
Clinical audit
Clinical effectiveness
Research and development
Openness
Risk management
Information management
Table 1: Definition of words and acronyms in the balanced scorecard according to clinical governance, EFQM,and JCI
Criteria of EFQM model
Code Axles of clinical governance Code
Leadership 1 Education & training 1
Strategy 2 Risk management 2
People 3 Research and development
3
Partnership & resources
partnership
4 Information management 4
Processes, products & services 5 Clinical effectiveness 5
Customer results 6 Clinical audit 6
People results 7 Openness
7
Society results 8
Business results
9
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 8 of 16
Code Standards JCI
1 Patient & family rights (PFR)
2 Assessment of patient (AOP)
3 Care of patient (COP)
4 Patient & family education (PFE)
5 Medication management and use (MMU)
6 Anesthesia and surgical care (ASC)
7 Governance, leadership & direction (GLD)
8 Prevention and control of infection (PCI)
9 Quality improvement patient safety (QPS)
10 Facility management & safety (FMS)
11 Staff qualification and education (SQE)
12 Management of communication and information 9MCI)(MCI)
13 Patient & family rights (PFR)
Environmental
Assessment
Type of
components assessed areas
Strateg
y-
driven
financial
Quality
manage
ment
Quality
Assura
nce
In
Organ
ization
al
Out
Organ
ization
al
tool
s
Standa
rd
Clin
ical
Non-
Clinica
l
EFQM * * * * * * *
BSC * * * * * * * *
JCI * * * * * *
Clinical
Governance * * * *
The
proposed
model
(developed
BSC )
* * * * * * * * * *
Perspective of
BSC Clinical
Governance JCI EFQM
Community
stakeholders
and service
areas
Patient & public
involvement
Clinical audit
Patient & family rights (PFR)
Care of patient (COP)
Patient & family education (PFE)
Governance, leadership & direction (GLD)
Customer results
People results
Society results
People
Internal
processes
Patient safety
Risk management
Clinical
effectiveness
Access to care and continuity of care (ACC)
Patient & family rights (PFR)
Assessment of patient (AOP)
Care of patient (COP)
Patient & family education (PFE)
Prevention and control of infection (PCI)
Quality improvement patient safety (QPS)
Key results
processes , products
& services
Growth and
learning
Education &
Training
Clinical evidence
base , use of
information
Staffing, staff
management
Medication management and use (MMU)
Anesthesia and surgical care (ASC)
Quality improvement patient safety (QPS)
Facility management & safety (FMS)
Governance, Leadership & direction (GLD)
Leadership
People
Resources' &
partnership
People results
Key results
Financial ------ ------
Resources' &
partnership
Key results
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 9 of 16
Comparison of model components
Table combines, the components of JCI standards, clinical
governance and EFQM areas with balanced scorecard (BSC)
aspects and the hospital‟s scorecard is developed on this
basis.
Methodology
After integration and investigating the degree of overlap
among EFQM model criteria, clinical governance axles and
JCI standards, the expectations of each one of these models
or, in fact, their objective goals were investigated.
Finally, it was completely determined that all of these
models enjoy the themes of quality and security in the
hospital environment. Therefore, they can be addressed and
given priority over other areas and axles or given lower
priority. The organization‟s scorecard background along
with the strategic goals in each dimension was set as the
basis of the model. Then the overlap of other models with
strategic dimensions and goals was conducted. When the
goals were placed in the scorecard, the tasks of overlap and
finding equivalents were performed more easily because
there was a close match between some criteria of other
models and the organizational goals.
Then, other columns of the BSC that were derived from the
Hasheminejad hospitals integrated BSC model was added to
the present card.
A sample of the scorecard developed at the level of
organization is presented in Table 4….
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Hospital performance assessment (HPA) is carried out based
on the BSC on the basis of RADAR logic. In other words,
the results are measured in terms of the degree of achieving
objective goals/indices and monthly general goals, and
reported in a committee consisting of the organization‟s
leader and junior managers. Then, the red points on the
scorecard were discussed based on the achieved results and
the reasons for delay in measures or failure in achieving
expected results were investigated. Finally, some
recommendations are suggested. These recommendations
are either related to the processes and in need of change in
some administrative stages, or they are based on change in
the beneficiaries‟ expectations. The junior managers‟
comments were announced to the organization‟s
administrative managers, and they were asked to program
and administer the reforms. The administrative mangers
provided an operational plan for administering the reforms;
determine the authorities and the administration time and
taking measures towards a systematic and continuous
deployment by the cooperation of mediator mangers. The
efficacy and influence of the operational program were
investigated while administering the program through
measuring the indices or project advance, and the results
achieved from the balanced scorecard were analyzed again
in the meeting by the organization‟s junior managers. The
above cycle was conducted continuously and monthly, and
led to the continuous promotion and improvement of the
organization‟s operation. Since all managerial levels are
engaged in program administration and the implementation
of approaches and processes and because the results of the
organization performance are permanently accessible
through the BSC, they all are able to respond. Not only is
there the possibility to respond to the situation, but the
promotion process is presentable through the scorecard too.
Discussion and Conclusion
Shahid Hasheminejad Hospital is the first Iranian hospital
and organization that has used the BSC model operationally
during a 3 three-year program.
Jack Travet states: To be the first is a distinguishing idea,
but to remain and support this distinction, we should do our
best. Therefore, after other organizations decided to use the
BSC model, especially in the health industry, the
organization tried to create an integrative model. The
promoted BSC that was a combination of EFQM, clinical
governance and JCI models, made it possible for the
organization and its managers to resist and respond to their
needs in influx and desire to use each model requested by a
section of superior organization.
© 2016 Fatemeh Semnani and Rouhangiz Asadi. Volume 2 Issue 1 JBHRM-2-005 Page 14 of 16
Moreover, one of the fundamental values of the
organization, (that is continuous promotion through
promoted performance assessment system) was actualized.
Due to commitment to organizational values, all managers
and staff believe in continuous promotion and participation
in model implementation and program administration.
Finally, the use of this model combined the results of years
of using EFQM, clinical governance, and JCI model in
organization so that not only did not it result in the managers
and staff‟s fatigue and frustration, but also it was able to be
an appropriate form of the achieved results of years of
continuous endeavor and activity.
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