Improving Palestinian Healthcare Through Patient Participation in Balanced Scorecard Assessment: Policy Implications and Recommendations

Background

Balanced Scorecard (BSC) is a comprehensive performance evaluation (PE) tool used to assess and enhance the quality of healthcare institutions. This tool evaluates various aspects of performance metrics that includes the financial, internal, external, and management processes. However, patients’ perspectives are rarely explored despite their critical role in guiding the needed improvements. Failing to incorporate patients’ perspectives can adversely affect patient care and healthcare outcomes. This study aims at developing recommendations for policy makers that would enhance the healthcare experience of patients in Palestine.

Methods

The BSC-PATIENT survey was utilized in this study to assess patients' experiences and attitudes toward the BSC dimensions (BSCP-ATT) (Figure 1). Differences in evaluations by admission status, causal relationships between patients’ experiences and attitudes, and BSC strategic maps using patient evaluation were analyzed.

Results

A total of 740 participants were recruited from 18 different hospitals in the Palestinian territories between January and October of 2021. Patients gave the highest ratings for service experiences and the lowest ratings for patient care experiences (Table 1). In total, patients' experiences accounted for 56.4% of the variance in their overall attitudes based on the BSC perspectives. The experience factors of information, patient care, service quality, and hospital facilities had the strongest positive impact on attitudes. There were significant differences between reported inpatient and outpatient patients’ experiences regarding their assessments of patient care, services, accessibility, and overall attitudes, with inpatient services providing more critical evaluations.

Conclusion

BSC-PATIENT effectively involved Palestinian patients in BSC-PE. This study highlights the pivotal role of patient care, services, and hospital facilities in shaping patient attitudes. Taking into account the importance of patients’ satisfaction in performance evaluations, Palestinian policymakers should priorities policies that improve patient care, services, and hospital facilities to enhance the healthcare experience of patients in Palestine.