Balanced scorecard em hospitais: uma avaliação das críticas associadas ao modelo a partir do estudo de caso em duas organizações hospitalares brasileiras

Abstract

This dissertation studies the use of Balanced Scorecard (BSC) in the National Institute of Cardiology (INC) and in the Hospital Sinai Mount (HMS). The theoretical summary - that it related problems that was associates to the hospitals, characterized as professional bureaucracy, and critics to the BSC - led to a suitable questionnaire to the context hospital and applied to the 42 employees, between doctors, nurses and administrators, including the responsible ones for the implementation of the BSC. The work concludes that the BSC surpassed the typical problems of the hospital organization, contributing for a larger participation of the professionals in the strategic management. The BSC allowed reducing the main problem of the hospitals, the lack of integration between the professionals and the others employees, without affecting the main force of the professional organization: the concentration of political power in the operating core. Only five respondents had disagreed that the BSC is applicable to the hospital context, and diverse critical and problems associates to the use of this tool, that was found in the literature, had been rejected in the result. The four perspectives had been considered adjusted to the hospital reality. Also it had fort agreement that the BSC allowed the strategic differentiation, while literature emphasizes that the administrators of this type of organization have difficulty in establishing a particular strategy. Few critical ones to the BSC had been confirmed in both the organizations. It was confirmed cultural imposition of the BSC. However, this was considered a positive aspect for the respondents. Also difficulties in the establishment of goals had been told. The results also indicate that the structural configuration of the hospitals influenced in the perception of its employees with regard to the BSC, and it was verified that the two hospitals had different points of view, as it was showed by the emphasis in some answers. The INC, the hospital that is closer to the professional configuration, demonstrated to greater resistance to the tool. Just the interviewed ones of this hospital had confirmed following the critical ones: the linking between the goals and the plan of remuneration must be effected in subjective way, leaving clearly that the BSC does not contemplate all the necessary points to the decision taking; the selective holism, in which some important variable would be outside of the model; the lack of dynamics in the alteration of the measures and relations of cause and effect; e the BSC still was characterized as being mechanic, and top-down. Finally, in the INC, there was one accented difference of perception between the doctors and the employees.