Do different uses of performance measurement systems in hospitals yield different outcomes?

Abstract

Background Inspired by the new public management movement, many public sector organizations have implemented business-like performance measurement systems (PMSs) in an effort to improve organizational efficiency and effectiveness. However, a large stream of the accounting literature has remained critical of the use of performance measures in the public sector because of the inherent difficulty in measuring output and the potential adverse effects of performance measurement. Although we acknowledge that PMSs may indeed sometimes yield adverse effects, we highlight in this study that the effects of PMSs depend on the way in which they are used. Purpose The aim of this study was to investigate various uses of PMSs among hospital managers and their effects on hospital outcomes, including process quality, degree of patient-oriented care, operational performance, and work culture. Methodology We use a survey sent to 432 Dutch hospital managers (19.2% response rate, 83 usable responses). For our main variables, we rely on previously validated constructs where possible, and we conduct ordinary least squares regressions to explore the relation between PMS use and hospital outcomes. Results We find that the way in which PMSs are used is associated with hospital outcomes. An exploratory use of PMS has a positive association with patient-oriented care and collective work culture. Furthermore, the operational use of PMSs is positively related to operational performance but negatively related to patient-oriented care. There is no single best PMS use that positively affects all performance dimensions. Practice Implications The way in which managers use PMSs is related to hospital outcomes. Therefore, hospital managers should critically reflect on how they use PMSs and whether their type of use is in line with the desired hospital outcomes.

The Performance Management Design in Public Hospitals: A Case Study

“…for budget control, process monitoring) being positively related to operational performance and negatively to patient-oriented care and exploratory use (e.g. to learn and improve) having a positive infl uence on work culture and patient-oriented care (van Elten et al 2019). Further results of this study suggest that incentive-oriented use (e.g.…”

“…Although the performance assessment in healthcare has its own history reaching to the eighteenth century (McIntyre et al 2001), many authors regard the New Public Management (NPM) as the primary driving force behind the implementation of performance measurement systems (PMS) and private sector techniques to improve the effi ciency of public healthcare (van Elten et al 2019;Bortolocci Espejo et al 2017;Schwartz and Deber 2016;Speklé and Verbeeten 2014;Nyland and Pettersen 2004). Although the specifi c form of NPM reforms varied across the countries, the issues accompanying the introduction of PMS in this environment appear to be similarly natured.…”

“…Both these pitfalls of PMS implementation are in line with the observation of Mannion and Braithwaite (2012), who categorized observed adversities of PMS introduction in English National Health Service (NHS) into four categories: poor measurement, misplaced incentives and sanctions, breach of trust, and the politicization of performance systems. Although these adversities may have arisen for various reasons, PMS use appears to be the common mediator of PMS success (van Elten et al 2019;Speklé and Verbeeten 2014). Van Elten et al (2019), in their study of PMS employed in Dutch hospitals, observed and categorized three diff erent uses of PMS with diff erent impacts on hospital output.…”

“…Although these adversities may have arisen for various reasons, PMS use appears to be the common mediator of PMS success (van Elten et al 2019;Speklé and Verbeeten 2014). Van Elten et al (2019), in their study of PMS employed in Dutch hospitals, observed and categorized three diff erent uses of PMS with diff erent impacts on hospital output. Regarding the quality of care, the results of this study presented the operational use (e.g.…”

Understanding the Uptake of Big Data in Health Care: Protocol for a Multinational Mixed-Methods Study

“…Performance fits the multidimensional character of public sector organizations [37,38]. The notion of multidimensionality is a central tenet of the distinction between financial and nonfinancial performance, as well as between processes and outputs/outcomes [39].…”