A Systematic Review of the Impact of Process-Oriented Hospital Design on Hospital Organizational Performance: A Balanced Scorecard Approach

Abstract Introduction: Traditional hospital structures often lead to fragmented care and inefficiencies. While process orientation has often been practiced and measured within siloed hospitals and models like Lean, Six Sigma, and TQM address specific issues, they do not tackle systemic problems. Process-oriented hospital design (POHD) offers a comprehensive solution by reorganizing the entire hospitals around patient care processes, improving coordination and outcomes. This study evaluates the impact of process-oriented hospital design on organizational performance using the Balanced Scorecard framework. Objective: To assess the impact of process-oriented hospital design on organizational performance, measured by the Balanced Scorecard framework. Method: This systematic review followed PRISMA guidelines and used the PICO framework to evaluate the impact of process-oriented hospital design on organizational performance. Studies published between 2007 and 2024 were included, sourced from databases like Scopus, EBSCOhost, and SpringerLink. Inclusion criteria focused on original English studies related to process orientation in hospitals and performance outcomes. Two independent reviewers screened the studies, resolving disputes with a third reviewer. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and data were analyzed through content analysis. Result: The review included five studies that measured process orientation dimensions in hospitals. These dimensions were mapped into a process-oriented hospital design to assess its impact on hospital organizational performance using the Balanced Scorecard (BSC) framework. Findings indicate that hospitals adopting process-oriented designs experience improvements across all BSC perspectives. Additionally, the CMS Hospital Quality Initiative was used to benchmark the effectiveness of POHD, further validating its comprehensive benefits. Conclusion: This research demonstrates that process-oriented hospital design (POHD) significantly enhances organizational performance in hospitals, as measured by the Balanced Scorecard (BSC) framework. Further research is needed to include patient feedback and develop universally applicable quality initiatives to fully assess POHD's effectiveness, especially in diverse healthcare settings.