Date of Conferral



Doctor of Business Administration (D.B.A.)


Business Administration


Gergana Velkova


Sixty-four United States hospitals closed for poor organizational performance during 2010 through 2016. Because of hospital closures, community members experienced delays in obtaining needed care, reduced access to specialty care, and increased travel distances. Based on the balanced scorecard model theory, the purpose of this qualitative single case study was to explore strategies that 10 health care leaders used at a healthcare organization in central Texas to prevent financial distress. Semistructured interviews were conducted and archival organizational accounting records were reviewed, including company surveys with employees and patients. Data were thematically analyzed and triangulated to ensure the trustworthiness of interpretations. The findings identified 3 themes: effective leadership to improve organizational performance; training, skills development and continuous learning to improve performance; and customer focus strategies to increase customer satisfaction. The findings of this study may contribute to social change by improving access to healthcare services, increasing access to specialty care, and increasing customer satisfaction.