Despite worldwide popularity, Balanced Scorecard (BSC) usage in local public sector NHS organisations is rare. This paper conditionally outlines grounds supporting such usage. In particular, the BSC’s contribution to improved accountability needs emphasising, and underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. Full customisation of the system for NHS usage, is then possible. Finally, to minimise organisational resistance, a streamlined BSC implementation approach is recommended.

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