Leveling the Components of Balanced Scorecard-Based Budgeting in Iran’s Healthcare Sector Using the ISM–MICMAC Approach

Abstract

The primary objective of this study was to level the components of Balanced Scorecard-based budgeting in Iran’s healthcare sector using the ISM–MICMAC approach, so that by establishing links among strategic objectives, budgeting processes, and performance evaluation, the efficiency and effectiveness of the financial system of healthcare centers can be enhanced. In terms of purpose, the present study was applied-developmental, and methodologically, it employed an exploratory mixed-methods design (qualitative–quantitative). In the qualitative phase, semi-structured interviews were conducted with 15 experts in the fields of healthcare and finance, and thematic analysis was used to extract the fundamental dimensions and components of the model. In the quantitative phase, Interpretive Structural Modeling (ISM) revealed seven levels of relationships among the identified factors. At this stage, data were collected using an ISM questionnaire completed by 15 executive and academic experts. Within this structure, some factors were positioned at the foundational levels as principal drivers that create the conditions for influencing other factors, whereas others were located at higher levels and were more strongly affected by other variables. According to the findings, factors such as the development of human capacities, strengthening of information infrastructures, and establishment of organizational learning platforms were positioned at the foundational levels and played an important role in shaping and reinforcing the other dimensions of the model. In contrast, factors such as improving data-driven decision-making and enhancing the efficiency of organizational processes were located at higher levels of the model and primarily emerged as outcomes of strengthening the foundational factors. The findings indicate that the simultaneous strengthening of human capital, information technology infrastructure, and an organizational learning culture can facilitate the transition of the budgeting system from a purely financial approach toward a strategic and performance-oriented approach.