Abstract This paper aims to assess the organizational structure and performances through the Balanced Scorecard of Malaysian private hospitals by focusing on top management's perceptions. A structured questionnaire was used and 97 private hospitals registered with the Association of Private Hospitals Malaysia were included in the survey. In total, 39 responses were received which resulted in an overall usable response rate of 40.2%. The descriptive results illustrated that the majority of the private hospitals that adopt the Balanced Scorecard are highly centralized and formalized. These private hospitals subscribed to formalized rules and written formal procedures to ensure the management and governance of the health providers act in accord with espoused values. As such, there is a legitimate link to improved performances within this sector on the key aspects: internal business processes, patient quality services, safety and satisfaction, organizational learning and growth, and financial. Thus far, despite the evidence from this study that can be attributed to becoming responsible healthcare providers, drivers used which incorporate responsibility, integrity, accountability and transparency in assessing performances can be taken up. This paper adds value to the limited academic BSC literature and responsible issues pertaining to quality improvements and patient satisfaction within the private healthcare sector in Malaysia.