Background: The Balanced Scorecard (BSC) is one of the most common applications of performance management in every type of organization all over the world. The literature studies reveal that there is an obvious lack of studies which focus on integrated approach for balanced scorecard stages. The aim of this study is to develop a new decision support framework for balanced scorecard in hospitals. Methods: An integrated hospital BSC approach is developed from vision to action as a whole. The approach including 10 stages is developed for hospitals, originally. The new decision support system framework helps to the managers of hospitals to design balanced scorecard effectively. Some hospitals in Turkey are visited to obtain necessary information. The hospitals with top management's commitment are selected. Results and Conclusions: The paper finds that an integrated approach should be applied for the implementation of balanced scorecard and expert knowledge is required for every stage of balanced scorecard to support hospital managers. The model gives recommendation for every stage of balanced scorecard and it is applied in a private hospital.