This project examines the development and impact of balanced scorecard (BSC) performance measurement in the United Kingdom (UK) and New Zealand (NZ) hospitals, focusing on how such systems work in practice. BSC style performance measurement systems have now been in place in NZ and UK hospitals for several years. This approach emerged from a perceived need for an appropriately balanced performance measurement strategy (broader than a purely fi nancial focus) in order to achieve the full benefi ts of health sector Performance management (see Northcott & Llewellyn 2004). This research is the fi rst empirical study conducted in either NZ or the UK to examine how these BSC Performance management approaches work in practice in the public sector, and specifi cally to support hospital Performance management.