Evaluating the influence of strategy execution using the Balanced Scorecard (BSC) on hospital performance: a case of a multispecialty hospital in rural Kenya

Abstract

This study examined the influence of Balanced Scorecard (BSC)-based strategy execution on hospital performance at South Rift Level 5 Hospital, a multispecialty private facility in rural Kenya. The study assessed the effects of BSC implementation, environmental factors, resource adequacy, and strategic alignment on hospital performance. Guided by the Resource-Based View, Configuration Theory, and the Balanced Scorecard framework, the study adopted a positivist, descriptive cross-sectional design. Data were collected from 92 employees using structured questionnaires and analyzed using descriptive statistics, correlation, and multiple regression in R software. Findings showed that BSC implementation had a significant positive effect on hospital performance (β = 0.186, p = .026). Environmental factors were the strongest predictor of performance (β = 0.413, p < .001), with patient affordability identified as the main constraint. Strategic alignment also significantly improved performance (β = 0.264, p = .008), demonstrating the importance of linking organizational objectives to operational activities. Although resource adequacy was positively perceived, it did not independently predict performance. The regression model explained 69.8% of the variance in hospital performance. The study concludes that effective strategy execution in rural hospitals depends on BSC implementation, strategic alignment, and a supportive operating environment. It recommends investment in staff development, digital BSC monitoring systems, and initiatives that improve patient access to health insurance. Given the study's cross-sectional and single-hospital design, the findings should be interpreted cautiously and validated through future multi-institutional research.