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Incorporating the environmental dimension into the balanced scorecard: A case study in health care

Salim Khalid (School of Commerce, University of Southern Queensland Faculty of Business Education Law and Arts, Toowoomba, Australia and Accounting Department, College of Administration and Economic, University of Mosul, Iraq)
Claire Beattie (School of Commerce, University of Southern Queensland Toowoomba, Australia)
John Sands (School of Commerce, University of Southern Queensland Toowoomba, Australia)
Veronica Hampson (School of Commerce, University of Southern Queensland, Springfield, Australia)

Meditari Accountancy Research

ISSN: 2049-372X

Article publication date: 8 July 2019

Issue publication date: 22 August 2019




This study aims to explore the ways that the balanced scorecard (BSC) can be adapted to incorporate environmental performance in a health care context.


This research adopts a qualitative approach that uses an in-depth case study including semi-structured interviews and document review. Interviews are conducted with individuals working within a regional public hospital and health service organisation in Australia. The research is informed by stakeholder theory.


The participants identified a number of approaches to incorporating environmental dimensions within the BSC: fully integrated, partially integrated, a separate additional perspective and differentiation based on the origin of the environmental activities and events. These findings confirm the contingent nature of the selected model and reinforce the importance of organisational vision and environmental strategy as formative factors.

Research limitations/implications

This research provides a starting point for future research to refine the proposed models and evaluate their viability and relevance in other contexts.

Practical implications

This study provides motivations for managers to engage with the BSC as an effective performance measurement system, which can be developed and adapted to incorporate important environmental elements of organisational performance.

Social implications

This study reveals the importance of difference between endogenous and exogenous environmental activities. As concerns around the environmental consequences of organisational activities continue to grow, opportunities for institutions to reassure stakeholders of their sustainable practices are increasingly critical.


This study presents preliminary evidence on the suitability of various models for integrating environmental dimensions within the BSC. The findings provide a valuable contribution to literature on performance measurement systems in the healthcare sector.



The authors wish to express their appreciation for the contribution of the Regional Health Service organisation for their willingness to provide access to managers for interviewing. The authors also acknowledge the usefulness comments received from the guest editors of this special issue of Meditari Accountancy Research and from two anonymous reviewers on earlier versions of the paper.


Khalid, S., Beattie, C., Sands, J. and Hampson, V. (2019), "Incorporating the environmental dimension into the balanced scorecard: A case study in health care", Meditari Accountancy Research, Vol. 27 No. 4, pp. 652-674.



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