A Meta-summarization of Qualitative Findings About Health Systems Performance Evaluation Models: Conceptual Problems and Comparability Limitations

Abstract

Due to the replacement of the issue of performance measurement in health policies worldwide this study identifies and analyzes the models for evaluating health systems performance. For this purpose, a systematic review of the literature on the topic “health systems performance evaluation” is done, making it compatible with a qualitative meta-synthesis of the type “meta-summarization.” It works with all databases related to the theme (PubMed, Scopus, EMBASE, PubAdm and Lilacs/Scielo). Portuguese, English, and Spanish are elected as language limit. Of the total number of articles (n = 32), 23 articles (71.8%) do not have a definition on “performance.” In those who have a definition, “performance” could be summed up in 6 central ideas. Among the most frequent subsidiary concepts that makes up the performance idea are the concepts of “efficiency” (11.9%), “quality” (9.5%) and “effectiveness” (7.1%). Six models were found in this review: “dashboard,” “balanced scorecard,” “open system model,” “PCATool,” “analyze dimension and performance indicators” and “standardized checklist and interview.” The “dashboard” was the most frequent performance evaluation model, found in 35.7% of studies. Only 25% of the reviewed studies presented the performance evaluation model applied specifically to health systems. Far from being configured as management tools useful to comprehension of health systems, these performance evaluation models have shortcomings that compromise their systemic evaluative power. This reinforces the inversion of reality in the relationship between quality and performance. Also, the performance evaluation models used try to adapt to the object, however in most them with relevant analytical problems compromising the specificities in depth of the health system under analysis. This generates inaccuracies and replaces the question about its use and their limitations to compare health systems.

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

“…This dimension should represent cost containment and financial measures 3 . Defined as financial performance in different frameworks, which is a dimension of the BSC, measures of efficiency are the appropriate levels of funding, the cost‐effectiveness of interventions, and the effective administration 25 . In light of emerging health system issues, financial measures are more and more strategic and consist in the enhancement of revenues, the control of expenses within budgetary constraints which is more crucial for the health organisations of the public sector where resources are even scarcer and the settlement of debt obligations within acceptable levels 21 .…”

“…3 Defined as financial performance in different frameworks, which is a dimension of the BSC, measures of efficiency are the appropriate levels of funding, the cost-effectiveness of interventions, and the effective administration. 25 In light of emerging health system issues, financial measures are more and more strategic and consist in the enhancement of revenues, the control of expenses within budgetary constraints which is more crucial for the health organisations of the public sector where resources are even scarcer and the settlement of debt obligations within acceptable levels. 21 The KPIs sets are then well in control and consist in debt ratio, cost per patient day, ratio of total revenue to total costs, NPM (Net Profit Margin), average value of DRG, average cost per DRG ROE (Return on Equity), fundraising, Return on investment (ROI), Cash Flow Solvency, % personal cost/total cost.…”

Tools and Methods Used in Performance Measurement in Healthcare

“…Sonuç olarak, etkililik, güvenlik, erişebilirlik, eşitlik, verimlilik, kabul edilebilirlik, hasta merkezlilik ve zamanındalık olmak üzere sekiz boyut öne çıkmıştır. Carnut ve Narvai [18] performans değerlendirmede kullanılan modelleri analiz ederek, verimlilik, kalite ve etkililik kavramlarını vurgulamışlardır. Hasta merkezliliğin, etkililiğin, verimliliğin ve güvenlik boyutlarının önemini vurgulayan Carini ve diğ.…”

Integrating Quality Tools and Methods to Analyze and Improve a Hospital Sterilization Process

“…Therefore, the main concern of healthcare supply chain management is its performance. In most studies, the concept of performance used quality as its dimension [24]. For this reason, healthcare managers have turned to total quality management (TQM) [25], since implementing TQM tools and techniques enables organizations to capture and re-design their services to meet customers' requirements, help with creative thinking and problem solving, and produce continuous improvement in performance.…”