Reconceptualizing the balanced scorecard as a communication mechanism in healthcare

The Balanced Scorecard (BSC) has been widely implemented in healthcare organizations primarily as a performance measurement system, yet its potential as a communication tool remains underexplored. This is particularly important given that communication failures have been implicated in over 70% of sentinel events in healthcare settings, making effective communication a critical determinant of patient safety and quality of care. This conceptual paper integrates micro-level communication constitutes organization (CCO) theory with macro-level corporate communication theory adapted for healthcare contexts to develop a multilayered model for analyzing BSC as a communication tool. Our framework consists of four interconnected layers: healthcare values foundation, BSC perspectives, healthcare communication processes (clinical strategic, interprofessional coordination, and healthcare stakeholder communication), and constitutive processes. We demonstrate the framework's application through an electronic medical record implementation case and propose a Healthcare BSC Communication Matrix as a practical evaluation tool for healthcare leaders. This study reconceptualizes the BSC as a constitutive communication mechanism that can transform abstract healthcare values into measurable objectives, coordinate improvement efforts across disciplinary boundaries, and communicate progress to diverse stakeholders, offering both theoretical advancement for researchers and practical guidance for healthcare leaders seeking to enhance organizational communication through more effective BSC implementation.