The use of multilevel performance indicators in managing performance in health care organizations

The performance construct may be one of the most elusive in organization theory. Health care organizations are particularly complex owing to their dual lines of accountability, i.e. professional and administrative. This article examines the factors affecting performance indicator development and use at the technical/managerial and institutional levels, including the accreditation process and the relationship between levels. Using institutional and rational/goal theory, the motivations behind performance measurement behavior at different organizational levels was explored. Results show that the institutional level is motivated by legitimacy while the technical/managerial level is motivated by rationality. Tensions exist between the two levels and between indicator development and use.

[1]  S. Davis,et al.  Structure and Process , 2003 .

[2]  Use of mid-level indicators in determining organizational performance. , 2000, Hospital quarterly.

[3]  Barbara Townley,et al.  The Role of Competing Rationalities in Institutional Change , 2002 .

[4]  G R Baker,et al.  A Conceptual Framework for the Analysis of Health Care Organizations' Performance , 1998, Health services management research.

[5]  W. Richard Scott,et al.  Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care , 2000 .

[6]  Talcott Parsons,et al.  Structure and Process in Modern Societies , 1961 .

[7]  Arnold S. Tannenbaum,et al.  A Study of Organizational Effectiveness , 1957 .

[8]  D. Whetten,et al.  Organizational Effectiveness: A Comparison of Multiple Models , 1984 .

[9]  James L. Price,et al.  The Study of Organizational Effectiveness , 1971 .

[10]  T. Davenport,et al.  Data to Knowledge to Results: Building an Analytic Capability , 2001 .

[11]  W. Scott,et al.  A Multidimensional Model of Organizational Legitimacy: Hospital Survival in Changing Institutional Environments , 1998 .

[12]  G R Baker,et al.  A Review of Organizational Performance Assessment in Health Care , 1998, Health services management research.

[13]  Harlow B. Cohen.  The performance paradox , 1998 .

[14]  K N Lohr,et al.  Medicare: A Strategy for Quality Assurance , 1991, Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals.

[15]  Joseph S. Wholey.  Performance-Based Management: Responding to the Challenges , 1999 .

[16]  W. Powell,et al.  The iron cage revisited institutional isomorphism and collective rationality in organizational fields , 1983 .

[17]  James D. Westphal,et al.  Customization or Conformity? An Institutional and Network Perspective on the Content and Consequences of TQM Adoption , 1997 .

[18]  P. Julnes,et al.  Promoting the Utilization of Performance Measures in Public Organizations: An Empirical Study of Factors Affecting Adoption and Implementation , 2001 .