Palomar Pomerado Health adopted the balanced scorecard framework as a tool to heighten accountability for the annual and long-term goals of the health system, as well as to provide a structure to improve communication of health system and departmental goals throughout the organization. Take a closer look at what a balanced scorecard is, how it links to strategic planning and execution, how a hospital can initiate a balanced scorecard, and what decisions need to be made in the process. Examine a paper versus an automated system, as well as benefits, challenges, and key success factors in implementing a balanced scorecard framework.