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Bureaucracy and the balanced scorecard in health care settings

Helena Costa Oliveira (Porto Business and Accounting School, Polytechnic of Porto, Porto, Portugal)
Lúcia Lima Rodrigues (School of Economics and Management, University of Minho, Braga, Portugal)
Russell Craig (Faculty of Business, Durham University, Durham, UK)

International Journal of Health Care Quality Assurance

ISSN: 0952-6862

Article publication date: 7 April 2020

Issue publication date: 20 April 2020




We explore the relationship between the balanced scorecard (BSC) and neo-bureaucracy by investigating whether the operationalization of the BSC incorporates “neo-bureaucratic” ideas and whether the BSC implemented in a Portuguese Local Health Unit (LHU) demonstrates a neo-bureaucratic approach.


We conduct semi-structured interviews with LHU staff and analyse documents to assess whether features of bureaucratic organization were evident in the use of a BSC by the LHU.


We found nine bureaucratic features evident in the LHU's BSC. These were systematization, rationality, authority, jurisdiction, professional qualification, knowledge, discipline, transparency and accountability. The BSC used at the LHU demonstrated a neo-bureaucratic approach.


Our study helps to demystify bureaucracy and overcome prevailing prejudices regarding some of its principles. Health care managers should recognize and endorse neo-bureaucratic principles in developing a BSC. They should recognize the BSC as involving a neo-bureaucratic approach. The BSC is a valuable management tool that hospital managers should find useful in fostering flexibility, collaboration, innovation and adaptation – all of which should help lead to improved healthcare outcomes.



The authors would like to thank the collaboration of the Local Health Unit managers to this research. This article is financed by National Funds of the FCT – Portuguese Foundation for Science and Technology within the project UID/ECO/03182/2019.


Oliveira, H.C., Rodrigues, L.L. and Craig, R. (2020), "Bureaucracy and the balanced scorecard in health care settings", International Journal of Health Care Quality Assurance, Vol. 33 No. 3, pp. 247-259.



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