Developing a Balanced Scorecard Adapted to Moroccan Hospitals in Light of New Public Management and Paradox Theory

Abstract

In an environment characterized by budgetary constraints and reforms inspired by New Public Management, Moroccan public hospitals face an unprecedented performance imperative.

The Balanced Scorecard (BSC), a proven strategic management tool in Western countries, represents a promising avenue but poses specific implementation challenges in the health systems of developing countries.

This study examines to what extent the implementation of the BSC generates organizational paradoxes and how these paradoxes affect the effectiveness of hospital management in Morocco.

Drawing on paradox theory, this research investigates the organizational paradoxes related to its implementation. A qualitative approach was adopted, using ten semi-structured interviews with hospital managers (administration, finance, human resources, and nursing care). Data were processed using NVivo 10, employing thematic and lexical analysis that combined open and axial coding to identify themes and their interrelationships.

Three major paradoxes were identified: financial performance vs. quality of care, innovation vs. regulatory compliance, and departmental autonomy vs. strategic coherence.

The "patient" perspective shows a strong correlation with overall performance (r = 0.43).

The financial and internal process perspectives show moderate correlations (r = 0.23).

Organizational learning reveals a weak correlation (r = 0.12).

The BSC proves relevant for the strategic management of Moroccan hospitals, provided it is adapted to the local context. Managing paradoxes and strengthening managerial competencies appear essential to reconcile efficiency, quality, and organizational coherence.