Strategic responses to Performance Measurement in Nonprofit ...

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et al. 2003, Bedford et al. 2008, Schaeffer and Matlachowsky 2008). It predominately focuses
on very large organisations. The experience with the balanced scorecard in the for-profit
sector is described as mixed (Ittner et al. 2003, Bedford et al. 2008, Schaeffer and
Matlachowsky 2008, Ittner and Larcker 2009). Challenges reported include how to link the
performance indicators to an incentive system or how to make it a strategic management
system. The implementation is a time-consuming process and difficulties were encountered
with respect to cause-and-effect relationships (Greiling 2010). Schaeffer and Matlachowsky
(2008) report on cases where fully-fledged balanced scorecards were abolished due to a
change in the top management or because the gathering and monitoring of the balanced
scorecard indicators were seen as a no-value-adding burden. Due to the difference in size,
number of employees and general strategic orientation, the findings from those studies cannot
be transferred one-to-one from for-profit to non-profit organisations.
If we look at empirical papers which go beyond single case studies (for a literature review see
Urrutia and Scott 2005, Gurd and Gao 2008, Kocakülah and Austill 2007, Greiling 2010) the
body of research gets very small for health and social non-profits. While there is no research
which focuses explicitly on the implementation of the balanced scorecard in the social sector,
a few empirical studies do focus on the balanced scorecard in the health care sector (e.g. Chan
and Ho 2000, Hermann et al. 2000, Aidenmark 2001, Kershaw and Kerschaw 2001, Pink et
al. 2001, Voelker et al. 2001, Randor and Lowell 2003a and 20003b, Zelman et al. 2003).
With respect to the non-profits in health care only very few examples of comparative studies
(Inamdar and Kaplan 2002, Contrast Management Consulting 2002, Greiling 2009) could be
identified. While the two last mentioned do not focus exclusively on the balanced scorecard,
Inamdar and Kaplan (2002) interviewed nine managers of non-profit hospitals which were in
an early stage of implementing the balanced scorecard. The introduction of the balanced
scorecard took an average of two years and pay-off of this time-consuming endeavour was a
measurable performance improvement (Inamdar and Kaplan 2002: 194). According to these