The Balanced Scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations.

Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations. Full English text available from:www.revespcardiol.org.