Abstract
Small and Medium sized hospitals are exposed to severe managerial environments recently. Around 8.0% of the hospitals are bankrupted every year. The adverse managerial environment does not only come from external factors such as patients' preference for larger hospitals, regulations on the medical charges; more serious problems come from the way the medium and small sized hospitals deal with those exogenous changes including lack of management skills, lack of change management skills, lack of managerial decision support systems, etc. This paper aims to support managers to make decisions regarding the exogenous changes. This paper can be interpreted as an attempt of a merge of the two techniques; BSC and system dynamics. Starting with a BSC system, the development of a system dynamics model can take advantages of the BSC information.
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