A Review of Organizational Performance Assessment in Health Care

Abstract

As health care organizations look for ways to ensure cost-effective, high quality service delivery while still meeting patient needs, organizational performance assessment (OPA) is useful in focusing improvement efforts. In addition, organizational performance assessment is essential for ongoing management decision-making, operational effectiveness and strategy formulation. In this paper, the roles and impact of OPA models in use in health care are reviewed, and areas of potential abuse, such as myopia, tunnel vision and gaming, are identified. The review shows that most existing OPA models were developed primarily as sources of information for purchasers or consumers, or to enable providers to identify areas for improvement. However, there was little conclusive evidence evaluating their impact. This review of existing OPA models enabled the establishment of principles for the development, implementation and prevention of abuse of OPA specific to health care. The OPA models currently in use in health care may provide managers with false confidence in their ability to monitor organizational performance. To further enhance the field of OPA, areas for future research are identified.

Performance monitoring in the Victorian health care system: an exploratory study

“…14 The balanced scorecard, with a 'balance' of financial, operational and customer satisfaction indicators, as a foundation to strategy maps, has been identified as an effective tool to monitor and improve organisational performance. 5,15 There is overwhelming evidence of the need for organisations to derive their performance measures from strategic objectives, 7,[16][17][18][19] and ensure that mechanisms are in place to measure achievement of mission and strategy. 20 But this was not evident in this study.…”

“…2,5,6 Performance information is important to improving organisational effectiveness, ensuring accountability, monitoring management and fostering collaboration within the sector. 7 The experience of health service organisations in monitoring performance has suggested the need to consider a range of performance indicators including financial indicators; service indicators that focus on satisfaction with service delivery; and clinical indicators that evaluate the processes of care and/ or the resulting patient outcomes. 8 These indicators can be realised and acted upon through regular reporting to and monitoring by decisionmaking bodies and key stakeholders, 9 through benchmarking with like organisations 10 and through making links to staff performance.…”

“…7,8,15,25,26 There are also other sources of requirements for a balanced set of performance indicators, including important changes to corporate reporting and international financial reporting standards, 27 increasing requirements for strong corporate governance 28 and greater awareness of the information needs of the different stakeholders. 9 Organisational requirements for monitoring performance Although there is a strong body of literature that confirms the performance benefits of benchmarking, 6,10,29 the CEOs reported relatively limited use.…”

Performance Measurement in Healthcare: Part II - State of the Science Findings by Stage of the Performance Measurement Process

“…Second, causal links between service and health outcomes are very difficult to specify for both medical and public health interventions, owing to the limits of evidence in medicine and the reality that healthcare is only one of several predictors of health status (Williams et al 1992;Handler et al 2001;Leggat et al 1998). …”

“…The development of measures databases is a welcome sign that this duplication of effort may be waning (e.g., Jennings and Staggers 1999;Hermann et al 2000). Collaborative efforts to standardize measures are another promising development (Braun and Zibrat 1996;Leggat et al 1998).…”