Medical record data during 2010-2012 showed the pediatric ward in Pamekasan Hospital had the lowest values of BOR and never reach standards 75%.This study aimed to analyze the Pediatric ward performance using balanced scorecard.This was a descriptive-observational study with qualitative and quantitative approaches. The study used cross sectionaldesign. Questionnaire for external customer were given to the families of patients with a sample size of 100 peoples. Other questionnaire was given to 16 employees as internal customer. Interviews and secondary data collection on proses bisnis internal process, and learning and growth perspective were given to the leader of each. Scoring and weighting results showed the financial perspective was bad (-0.275). Other prespective, customer focus was good (+1.089). Unfortunatley this was not supported by its internal business process perspective which catogarized as mostly bad (-2.000) and bad learning and growth perspective (- 0.100). The conclusion was the customer perspective only positive values among the four perspectives. It was important to implement a customer-focused service to improve performance based on the application of training, innovation, and dissemination Standard Operational Procedure and so that performance assessment can be made, and doing recording expenses so that profits can be known. Keywords: balanced scorecard, Pediatric Ward Performance, Scoring and weighting