Document Type : Original Article


1 Department of Medical Records, Dr. Ali Shariati Hospital, Isfahan

2 Department of Health Services Management, Health Management Research Center, Baqiyatallah Institute of Medical Sciences, Tehran

3 Department of Health Information Technology, School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran


Context: The Medical Records Department (MRD) is an important source for evaluating and
planning of healthcare services; therefore, hospital managers should improve their performance
not only in the short-term but also in the long-term plans. The Balanced Scorecard (BSC) is
a tool in the management system that enables organizations to correct operational functions
and provides feedback around both the internal processes and the external outcomes,
in order to improve strategic performance and outcomes continuously. Aims: The main
goal of this study was to assess the MRD performance with BSC approach in a hospital.
Materials and Methods: This research was an analytical cross-sectional study in which data
was collected by questionnaires, forms and observation. The population was the staff of the
MRD in a hospital in Najafabad, Isfahan, Iran. Statistical Analysis Used: To analyze data,
first, objectives of the MRD, according to the mission and perspectives of the hospital, were
redefined and, second, indicators were measured. Subsequently, findings from the performance
were compared with the expected score. In order to achieve the final target, the programs,
activities, and plans were reformed. Results: The MRD was successful in absorbing customer
satisfaction. From a customer perspective, score in customer satisfaction of admission and
statistics sections were 82% and 83%, respectively. Conclusions: The comprehensive nature of
the strategy map makes the MRD especially useful as a consensus building and communication
tool in the hospital.


1. Imbiorski W. Evaluating the quality of medical record services.
Chicago: American Medical Record Association; 1979.
2. Cobbold L, Lawrie G. Classification of balanced scorecards based on
their intended use, Presented at PMA Conference. USA: Boston; 2009.
3. Gerke and Associates Inc., Consultation to Management. Balanced
scorecard analysis. Consultants to management. 2007. p. 1-4.
4. Rabbani F, Lalji SN, Abbas F, Jafri SW, Razzak JA, Nabi N, et al.
Understanding the context of balanced scorecard implementation:
A hospital-based case study in Pakistan. Implement Sci 2011;6:31.
5. Department of Health and Human Services. USA, US Department
of Health and Human Services, Health Resouses and Services
Administration Balanced scorecards for small rural hospitals
concept overview and implementation guidance. Washington, D.C.:
U.S. Dept. of Health and Human Services, Health Resources and
Services Administration; 2005.
6. Weir E, d’Entremont N, Stalker S, Kurji K, Robinson V. Applying
the balanced scorecard to local public health performance
measurement: Deliberations and decisions. BMC Public Health
2009;9:127. Available from:
pubmed/19426508 [Last accessed on July 01,2012].
7. Stewart AC, Carpenter-Hubin J. The Balanced Scorecard: Beyond
Reports and Rankings, Planning for Higher Education, 2000-2001;
8. Rabbani F. Science and practice of balanced scorecard in a hospital in
Pakistan feasibility, context, design and implementation. Stockholm
Available from:
[Last cited on 2010].
9. Cheng SM, Thompson LJ. Cancer care ontario and integrated
cancer programs: Portrait of a performance management system
and lessons learned. J Health Organ Manag 2006;20:335-43.
10. Ontario. Ministry of H, Long-Term C, Canadian Institute for Health I,
Ontario Hospital A. Hospital report 2007 acute care. Ottawa, Ont.:
Canadian Institute for Health Information; Available from: http:// [Last cited on 2007].
11. Young J, Bell R, Khalfan A, Lindquist E. Evaluating the balanced
scorecard at the University Health Network: An impact assessment.
Healthc Q 2008;11:52-6, 2.
12. Woodward G, Goel V, Manuel DG. Institute for clinical evaluative
sciences in O. Developing a balanced scorecard for public health.
Toronto: ICES; 2004.
13. Gholami H. Identifying important factors to establish balanced
scorecard [Research in Persian]. Tehran: Iran Khodro Diesel, 2007.
14. Chan YC, Kathy Ho SG. The use of balanced scorcard in Canadian
Hospitals. Canada: McMaster University; 1999.
15. Nejati M, Ghasemi S, Nejati M, Shafaee A. Performance evaluation
of universities and higher education institutions; by Using balance
scorecard [Research project in Persian]. Yazd, Iran: Yazd University;