Implementing a balanced scorecard-driven performance dashboard for governance in a public oncology centre in Morocco

Abstract

Background: Cancer care in low- and middle-income countries (LMICs), including Morocco, is constrained by fragmented information systems, non-standardised indicators and limited integration of clinical, financial and administrative data. These weaknesses undermine governance capacity, impair care coordination and delay evidence-informed decision-making. Aim: To co-design and implement a balanced scorecard (BSC)-based digital performance governance model in a public university oncology centre in northern Morocco. Setting: The study was conducted at a public tertiary oncology centre integrated into Morocco's National Cancer Control Programme. Methods: A qualitative participatory action research (PAR) design was used. Multidisciplinary workshops and semi-structured interviews supported the development of a BSC framework and the validation of 21 performance indicators across five perspectives: clinical results, financial sustainability, patient experience, internal processes and learning and growth. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) were integrated into a digital dashboard. Descriptive statistics and thematic analysis were conducted within the PAR and BSC framework. Results: Operational indicators, including treatment completion and equipment utilisation, were high (≈90%), reflecting strong technical capacity. Diagnostic delays and late-stage presentation remained frequent. Patient-centred processes were weaker: satisfaction with care coordination and supportive services was suboptimal, and coverage of psychosocial and nutritional support was limited. Learning and growth indicators showed moderate staff training and restricted access to innovation. Conclusion: The BSC-based digital model improved transparency, coordination and strategic alignment, representing a replicable and contextually adaptable governance approach for oncology services in LMICs. Contribution: This study provides a replicable framework linking clinical performance, patient experience and organisational learning.