The Swedish healthcare systems have over the past decades experienced a major reorganization that involves reduction of costs and cuts due to the financial problems that the public health system faced. Healthcare was criticized because it was considered to be bureaucratic and inefficient (Funck, 2007). The solution to this problem was to focus on other measures rather than the economic measures, such as modernizing the healthcare instead of cutting down. Implementing a balanced scorecard in a public sector as a hospital, perceived as failures. This is due to several factors such as communication, knowledge and expected time are not taken into consideration when implementing the scorecard. The purpose of this study is to analyze how the balanced scorecard serves as an approach for controlling the hospital. The purpose of the study is to increase our knowledge and get better insight by examining the problems that may arise during the implementation of a balanced scorecard. The chosen method to this study is qualitative research with the influence of the inductive approach. Eight interviews were carried out at the Sahlgrenska University Hospital to get an overview about the selected topic. The chosen theory to the study is based on Kaplan and Norton's theories and other scientists as Funck, Assiri, Johnson and Atkinson. The study also applied research articles and literature in the theoretical framework. The study's research question is clarified as what types of problems can arise during the design and implementation of a balanced scorecard in hospitals. We have found that the balanced scorecard requires success factors such as communication, knowledge and learning, motivation, commitment, time management, a relevant and easy used scorecard and a clear vision, strategy and results for a successful implementation.