Ordination Balanced Scorecard översättning av ett styrinstrument inom hälso- och sjukvården

Detta är en avhandling från Växjö : Växjö University Press

Sammanfattning: This study examines the implementation of Balanced Scorecard (BSC) in health care organisations. BSC, a management control model based on measurements in different perspectives, has become one of the most popular performance measurement models during the last two decades and widely adopted in practice. However, studies have noticed that models are rarely used in the same way in different settings. From the perspective of Scandinavian institutionalism, a model that is moved from one place to another has been "translated." Translation is a process in which an abstract idea is transferred into an object, developed into practical use, and stabilised into an institution. The purpose of this study is to contribute to the understanding of how a management control model influences and is influenced by the medical professional context. The ambition is to investigate how BSC has been translated in the Swedish and the Canadian health care contexts. Furthermore the purpose is to develop our understanding of measurements in professional organisations and to develop our understanding of the translation process.The study shows that the main purpose of implementing BSC in the health care organisations is to support improvements in the quality of care. Whereas a free translation process in the Swedish case allowed actors to interpret and reinterpret the model and to create specific performance measurements for reporting professional performance, a controlled translation process in the Canadian case resulted in medical professionals being unable to reinterpret the model. Instead, BSC came to represent the private company's way of acting, declaring disciplinary accountability and shifting interest from public administration and towards the business firm. Based on the findings, this study stresses that a model can materialize both in the forms of practical use and talk, and that different translations can result in disputes and negotiations among actors with different interests. This study also analyses and develops the concept of transparency, and suggests that actors will use different performance measurements depending on what type of transparency (openness, visibility or hyaline) is requested. Finally, it is suggested that disciplinary accountability may result in actors focusing on finding the perfect measurements, whereas socializing form of accountability may create a greater focus on reciprocal accountability for improvements.