title: Multidimensional evaluation of performance with experimental application of balanced scorecard: a two year experience.
abstract: BACKGROUND
  In today's dynamic health-care system, organizations such as hospitals are required to improve their performance for multiple stakeholders and deliver an integrated care that means to work effectively, be innovative and organize efficiently. Achieved goals and levels of quality can be successfully measured by a multidimensional approach like Balanced Scorecard (BSC). The aim of the study was to verify the opportunity to introduce BSC framework to measure performance in St. Anna University Hospital of Ferrara, applying it to the Clinical Laboratory Operative Unit in order to compare over time performance results and achievements of assigned targets.
  
  
  METHODS
  In the first experience with BSC we distinguished four perspectives, according to Kaplan and Norton, identified Key Performance Areas and Key Performance Indicators, set standards and weights for each objective, collected data for all indicators, recognized cause-and-effect relationships in a strategic map. One year later we proceeded with the next data collection and analysed the preservation of framework aptitude to measure Operative Unit performance. In addition, we verified the ability to underline links between strategic actions belonging to different perspectives in producing outcomes changes.
  
  
  RESULTS
  The BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the specific perspective contribution to overall performance enhancement. After time results comparison was possible depending on the selection of feasible and appropriate key performance indicators, which was occasionally limited by data collection problems.
  
  
  CONCLUSIONS
  The first use of BSC to compare performance at Operative Unit level, in course of time, suggested this framework can be successfully adopted for results measuring and revealing effective health factors, allowing health-care quality improvements.
authors.affiliation: Section of Hygiene and Occupational Medicine, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lupi
authors.affiliation: Management Planning and Control St. Anna University Hospital, Ferrara, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Verzola
authors.affiliation: Analysis Laboratory, St. Anna University Hospital, Ferrara, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Carandina
authors.affiliation: Management Planning and Control St. Anna University Hospital, Ferrara, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Salani
authors.affiliation: Medical Direction Committee, St. Anna University Hospital, Ferrara, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Antonioli
authors.affiliation: Section of Hygiene and Occupational Medicine, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Gregorio