Performance feedback in healthcare organizations: The role of accountability measures and competition.

This study examines the impact of accountability arrangements in the form of performance feedback on organizational behaviors among healthcare organizations. Specifically, it evaluates the effectiveness of a performance management program implemented in South Korean healthcare settings, focusing on antibiotic prescription patterns. The study presents three key findings. First, significant performance improvement occurred mainly among low performing organizations. Second, public healthcare organizations exhibited greater performance enhancements compared to their private counterparts. Third, organizational responses to performance feedback were more pronounced when robust competition prevailed among the assessed healthcare institutions. This synergy between performance management and competitive environments was primarily evident in private organizations.

Towards performance governance in healthcare: An analysis of Italian local health units.

PURPOSE: Bouckaert and Halligan (2008) proposed four ideal types of performance management systems, ranging from a disconnected and input-led approach (performance administration) to a model in which performance management is fully integrated with both the internal and external context of an organisation (performance governance). This article empirically analyzes performance plans issued by Italian Local Health Units (LHUs) to provide a first nationwide snapshot of the different ideal-types of performance management that each (LHUs) have reached, in a 'performance governance'-oriented perspective. DESIGN: This paper employs a qualitative methodology based on document analysis. The model orienting the analysis features six dimensions capturing the ideal-types characteristics and what the Italian performance regulations prescribe. Data was derived from the performance plans adopted by the Italian LHUs on the condition that they made the documentation necessary for the analysis public on their institutional website. FINDINGS: For a 'performance governance' oriented approach, two elements are considered relevant: familiarity with the analysis of stakeholders and context. In our sample, consisting of 63 performance plans out of 99 Italian LHUs, it was challenging to identify specific territorial clusters, due to significant heterogeneity. The role of strategic objectives, integration between cycles, and context analysis seems to positively influence the orientation towards a 'performance governance' approach. ORIGINALITY/VALUE: The application of Bouckaert and Halligan's ideal-types has only been episodically investigated in the healthcare sector, mainly at the individual health unit or Region level. This article's innovative contribution consists of conducting a qualitative analysis based on a replicable taxonomy that enables further national comparisons. Furthermore, it highlights the need for public healthcare systems to engage more with external stakeholders to improve the quality of their performance governance.

Toward a sustainability performance management framework.

Although the United Nations (UN) has continued to introduce the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) to address global sustainability, the world is becoming less sustainable. This is not surprising since our knowledge about effective sustainability performance management is scanty. The present study attempts to develop a sustainability performance management framework to deal effectively with the prevailing sustainability problems. It starts by introducing the "wicked" nature of sustainability problems, followed by a research methodology to build the sustainability performance management framework. The review suggests that the framework's components are related to the organizational culture of sustainability, the sustainability strategy employed by the firm, the corporate sustainability practices implemented, and the resulting outputs and outcomes in terms of sustainability performance. The connections between these elements are fundamentally critical, along with a feedback loop to address the dynamic, wicked sustainability problems. Finally, a Sustainability Performance Management framework and its associated propositions are derived, followed by future research directions and practical implications.

Government policies on job satisfaction of radiographers in tertiary hospitals, Gauteng.

Background: The National Department of Health has different operational policies to monitor the performance of its employees and to reward them accordingly. These policies could have a direct bearing on job satisfaction and career advancement for radiographers employed by the public sector, as there are previous reports that show that these policies affect the job satisfaction of other healthcare professionals negatively. Aim: The aim of the study was to explore the influence of government policies on the job satisfaction of radiographers employed by public tertiary hospitals in the Gauteng province. Setting: The study was conducted in two public tertiary hospitals in the Gauteng province. Methods: The study used a primary exploratory qualitative research design, with a purposive sampling technique. Data were collected through individual and focus group interviews. The researcher recorded and transcribed the interviews. Thematic analysis was used to analyse the data. Results: Three government policies had a negative impact on job satisfaction for radiographers. These were the Occupational Specific Dispensation (OSD), the Performance Management and Development System (PMDS) and the Employment Equity Act (EEA). The failure to effectively implement these policies also had a negative bearing on career pathing. Conclusion: The implementation and structure of these three government policies have resulted in job dissatisfaction amongst radiographers employed by public tertiary hospitals and reduced the structure of career pathing. Contribution: The study highlighted three government policies that negatively affect job satisfaction in Gauteng.

Performance measurement of Brazilian federal university hospitals: an overview of the public health care services through principal component analysis.

PURPOSE: This paper aimed to contextualize the process of public hospital providing services, based on the measurement of the performance of Federal University Hospitals (HUFs) of Brazil, using the technique of multivariate statistics of principal component analysis. DESIGN/METHODOLOGY/APPROACH: This research presented a descriptive and quantitative character, as well as exploratory purpose and followed the inductive logic, being empirically structured in two stages, that is, the application of principal component analysis (PCA) in four healthcare performance dimensions; subsequently, the full reapplication of principal component analysis in the most highly correlated variables, in module, with the first three main components (PC1, PC2 and PC3). FINDINGS: From the principal component analysis, considering mainly component I, with twice the explanatory power of the second (PC2) and third components (PC3), it was possible to evidence the efficient or inefficient behavior of the HUFs evaluated through the production of medical residency, by specialty area. Finally, it was observed that the formation of two groups composed of seven and eight hospitals, that is, Groups II and IV shows that these groups reflect similarities with respect to the scores and importance of the variables for both hospitals' groups. RESEARCH LIMITATIONS/IMPLICATIONS: Among the main limitations it was observed that there was incomplete data for some HUFs, which made it impossible to search for information to explain and better contextualize certain aspects. More specifically, a limited number of hospitals with complete information were dealt with for 60% of SIMEC/REHUF performance indicators. PRACTICAL IMPLICATIONS: The use of PCA multivariate technique was of great contribution to the contextualization of the performance and productivity of homogeneous and autonomous units represented by the hospitals. It was possible to generate a large quantity of information in order to contribute with assumptions to complement the decision-making processes in these organizations. SOCIAL IMPLICATIONS: Development of public policies with emphasis on hospitals linked to teaching centers represented by university hospitals. This also involved the projection of improvements in the reach of the efficiency of the services of assistance to the public health, from the qualified formation of professionals, both to academy, as to clinical practice. ORIGINALITY/VALUE: The originality of this paper for the scenarios of the Brazilian public health sector and academic area involved the application of a consolidated performance analysis technique, that is, PCA, obtaining a rich work in relation to the extensive exploitation of techniques to support decision-making processes. In addition, the sequence and the way in which the content, formed by object of study and techniques, has been organized, generates a particular scenario for the measurement of performance in hospital organizations.

The interplay between ethics, justice, corporate social responsibility, and performance management sustainability.

In the increasingly volatile 21st century globalized and interconnected business landscape, organizations face increasing scrutiny concerning their ethical behavior, social responsibilities, and overall performance. This paper looks at some of the factors that link the notions of ethics, justice, and Corporate Social Responsibility (CSR), with an eye to their theoretical underpinnings and complexities and their relationship to the efficient and sustainable operation of Sustainable Performance Management (with special emphasis on CSR). Drawing on theoretical foundations and empirical evidence, we provide practical recommendations for organizations to promote ethics, justice, CSR, and effective and sustainable performance management. Suggestions include fostering ethical leadership by modeling ethical behavior and promoting ethical decision-making. We believe that the suggested practical measures may bridge the gap between academic perspectives and the practical realities of ensuring favorable, sustainable, work climates and work processes.

Reconsidering performance management to support innovative changes in health care services.

PURPOSE: A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services. DESIGN/METHODOLOGY/APPROACH: The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control. FINDINGS: An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges. ORIGINALITY/VALUE: The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

Advancement, barriers and collaboration: the ABC's of addressing challenges and designing solutions between front-line physicians and business-oriented leaders.

BACKGROUND: The complexity of US healthcare has been increasing for many years, requiring clinicians and learners to understand care delivery systems in addition to clinical sciences. Thus, there has been a major push to educate faculty and trainees on healthcare functionality. This comes as hospitals expand into health systems requiring the help of more sophisticated expertise of departments such as operations excellence when problem-solving. As a medical student with a background in operations excellence, medical education leader and clinical administration leader all currently facilitating this transition, we wanted to reflect on the barriers we have experienced in clinical implementation of quality improvement projects and educating learners on the impact of operations excellence principles in their clinical education. METHODS: The ideas presented in this article were the result of a several collaborative discussion between the authors, on the key challenges to adopting operations excellence principles into health system science education. In an effort to add context to this reflection through the current body of research present, they supplemented a literature review on the topic which included 86 studies published between 2013 and 2021 regarding health systems science and healthcare leadership engagement in the USA. The themes that intersected between the literature review and the discussions were then expanded on in this paper. RESULTS: Through this process, we identified four challenges: (1) the difference in thinking styles, which we term, 'mental model differences'; (2) the strategic nature of process improvement projects and how that collides with physician priorities, or 'the chess game of stakeholder engagement'; (3) the language and precise methodology, or 'consistency of language and need for administrative resilience' and (4) the issue of teaching these concepts or bridging the learning gap.' CONCLUSION: In an increasingly complex healthcare landscape, physicians and trainee's need to bridge gaps between the mental models of administrative and clinical workflow.

Characterising the performance measurement and management system in the primary health care systems of Malawi.

BACKGROUND:  Performance Measurement and Management (PMM) systems are levers that support key management functions in health care systems. Just like many low- and middle-income countries (LMICs), Malawi strives to improve performance via evidence-based decision making and a suitable performance culture. AIM:  This study sought to describe PMM practices at all levels of primary health care (PHC) in Malawi. SETTING:  This study targeted three levels of PHC, namely the district health centres (DHCs), the zones, and the ministry headquarters. METHODS:  This was a qualitative exploratory research study where decision-makers at each level of PHC were engaged using key-informant interviews (KII) and focus group discussions (FGDs). RESULTS:  We found that there is a weak link among levels of PHC in supporting PMM practices leading to poor dissemination of priorities and goals. There is also failure to appropriately institute good PMM practices, and the use of performance information was found to be limited among decision-makers. CONCLUSION:  Though PMM is acknowledged to be key in supporting health service delivery systems, Malawi's PHC system has not fully embarked on making this a priority. Some challenges include unsupportive culture and inadequate capacity for PMM.Contribution: This study contributes to the understanding of the PMM processes in Malawi and further highlights the salient challenges in the use of information for performance management. While the presence of policies on PMM is acknowledged, implementation studies that deal with challenges are urgent and imperative.

Leadership in Veterinary Practice.

Veterinary practice ownership has long been a financially rewarding option. High time it was an emotionally rewarding one for all concerned, too. This is the gift that strong leaders bestow on those lucky enough to work on their team. If more of us developed these skills, the course of veterinary medicine would change inevitably for the good.

A mixed-method approach to examining the experiences of allied health clinicians and managers of the performance, appraisal and development framework in a regional health care service.

INTRODUCTION: Evaluating employee performance is important for organisational success however, limited research exists across the allied health workforce. OBJECTIVE: This study investigated allied health clinician and manager experiences and perceptions of the appropriateness of the performance and development (PAD) framework. DESIGN: A mixed methods design with purposive sampling was conducted in a medium size hospital and health service in regional Queensland to investigate the appropriateness of the PAD framework. A 29 item online survey collected likert scale and open ended responses. Identified respondents also completed a semi-structured interview. Aggregated satisfaction scores identifying PAD alignment, processes, education, resources and perceptions were analysed to identify organisational PAD appropriateness. Themes from interviews provided concurrent experiential data. FINDINGS: Eighty-five respondents completed the online survey and 20 interviews were conducted. A Chi-Square Goodness of Fit test revealed a significant (p < 0.05) clinician (n = 75) response of moderate dissatisfaction (36%) for the PAD framework, while managers (n = 10) were neither dissatisfied nor satisfied (50%) or moderately satisfied (40%). Clinician aggregated agreement responses were significantly (p < 0.05) higher for PAD alignment (45%), processes (63%), education (49%) and lower for feedback (33%) and resources (28%). Manager aggregated agreement responses were high for PAD alignment (85%), processes (55%), education (57%), feedback (65%) and perceptions (50%). Interviews (n = 20) revealed three themes: uncertainty around PAD framework; expectations for experienced leadership and importance of discipline specific knowledge. DISCUSSION: This study draws on both clinician and manager input to assess the overall PAD framework with responses favouring clinician dissatisfaction to the current process. CONCLUSION: The PAD framework is valuable for staff development when there is positive rapport and discipline alignment between both clinician and manager. Successful staff appraisals require efficient and appropriate documentation that promotes individual development, clinical performance and organisational priorities.

Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers.

AIM: The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs). BACKGROUND: Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers. METHOD: This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'. RESULT: Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.

Performance management system and its role for employee performance: Evidence from Ethiopian SMEs.

Small and mediumenterprises (SMEs) are crucial to Ethiopia's economy in creating jobs and reducing poverty. Despite the extensive literature on performance management systems (PMS) and employee productivity, there remain unanswered questions regarding which PMS predictors most effectively contribute to improved employee performance. This study aims to investigate the role of PMS in enhancing employee productivity in Ethiopian SMEs using both qualitative methods such as a literature review alongside quantitative techniques like linear regression analysis based on primary & secondary data sources. The findings provide valuable insights into effective strategies for implementing an efficient performance management system that can enhance employees' work outcomes within SMEs operating in Ethiopia.The results show that the implementation of an effective performance management system can significantly improve productivity among SMEs in Ethiopia. The five predictors identified by the linear regression model are important factors that contribute to better work outcomes among employees in Ethiopian SMEs; however, evaluation has been found to have the strongest positive relationship with improved job outcomes among those studied. Based on these findings, we recommend that SME owners/managers/HR professionals implement an effective performance management system that includes clear job responsibilities defined through performance planning, regular feedback provided about progress made towards goals set during the planning stage, periodic appraisals providing constructive criticism as well as recognition for good work done; offering training opportunities helping employees develop new skills or refine existing ones; rewarding high-performing employees who meet or exceed expectations with incentives such as bonuses or promotions can motivate them further.

A refined management system focusing on medication dispensing errors: A 14-year retrospective study of a hospital outpatient pharmacy.

Objectives: This study aimed to evaluate the efficiency of a 14-year refined management system for the reduction of dispensing errors in a large-scale hospital outpatient pharmacy and to determine the effects of person-related and environment-related factors on the occurrence of dispensing errors. Methods: A retrospective study was performed. Data on dispensing errors, inventory and account management from 2008 to 2021 were collected from the electronic system and evaluated using the direct observation method and the Plan-Do-Check-Act (PDCA) cycle. Results: The consistency of the inventory and accounts increased substantially (from 86.93 % to 99.75 %) with the implementation of the refined management program. From 2008 to 2021, the total number of dispensing errors was reduced by approximately 96.1 %. The number of dispensing errors in quantity and name was reduced by approximately 98.2 % and 95.07 %, respectively. A remarkable reduction in the error rate was achieved (from 0.014 % to 0.00002 %), and the rate of dispensing errors was significantly reduced (0.019 % vs. 0.0003 %, p < 0.001). Across all medication dispensing errors, human-related errors decreased substantially (208 vs. 7, p < 0.05), as did non-human-related errors also (202 vs. 9, p < 0.05). There was a correlation between the occurrence of errors and pharmacists' sex (females generally made fewer errors than males), age (more errors were made by those aged 31-40 years), and working years (more errors were made by those with more than 11 years of work experience) from 2016 to 2021. The technicians improved during this procedure. Conclusions: Refined management using the PDCA cycle was helpful in preventing dispensing errors and improving medication safety for patients.

Multi-Criteria Performance Analysis Based on Physics of Decision - Application to COVID-19 and Future Pandemics.

The purpose of this study is to present a novel perspective on decision support based on the conventional SEIR pandemic model paradigm considering the risks and opportunities as physical forces deviating the expected performance trajectory of a system. The impact of a pandemic is measured by the deviation of the social system's performance trajectory within the geometrical framework of its Key Performance Indicators (KPIs). According to the overall premise of utilizing Ordinary Differential Equations to simulate epidemics, the deviations are connected to several alternative interventions. The model is essentially built on two sets of parameters: (i) social system parameters and (ii) pandemic parameters. The ultimate objective is to propose a multi-criteria performance framework to control pandemics that includes a combination of timely measures. On the one hand, the current study optimizes prospective strategies to manage the potential future pandemic, while on the other hand, it explores the COVID-19 epidemic in the state of Georgia (USA).

Association Between Local Boards of Health Authority Over Budgets and PHAB Accreditation Standard Score.

Introduction: This study examined the relationship between local board of health authority and local health departments' budget-related activities and performance scores in the Public Health Accreditation Board standards while considering the governance structure under which the local health agencies operate. Methods: Data from 250 local health departments were obtained from the Public Health Accreditation Board and were combined with data from the 2016 National Association of County and City Officials Profile Survey. Multilevel regression analysis was used to examine the relationship between local board of health authority on local health departments' budget-related activities, using the governance structure as the group-level variable. Results: Analyses identified positive associations between local board of health authority on local health departments' budget-related activities and local health departments' aggregate average performance scores in Public Health Accreditation Board accreditation. No apparent association was found between the type of governance structure under which a local health department operates and performance scores in Public Health Accreditation Board accreditation standards, perhaps attributable to variation in the characteristics and roles of their governing bodies. Conclusions: The analyses suggest that local boards of health with authority related to local health departments' budgets appear to have an influential role in budget-related activities and may improve local health departments' performance scores in Public Health Accreditation Board accreditation standards. However, vast variations in more specific local boards of health roles and characteristics exist across local health departments and for which there are no national data. More research is thus needed to control for or examine the influences of specific local boards of health characteristics before the benefits of expanded local boards of health authority over local health departments' budgetary decision making on local health departments' performance can be fully understood.

[Analysis and Research on Comprehensive Evaluation Method of Operation Performance of Hospital Valuable Equipment].

OBJECTIVE: To study the effective method of comprehensive evaluation and analysis of hospital valuable medical equipment performance. METHODS: The operation performance of 6 valuable equipment was evaluated by cost-benefit method, comprehensive index method and public evaluation method. RESULTS: Utilize equipment information management methods for data collection and evaluation, and construct an assessment data model based on evaluation indicators from three aspects: equipment operation status, profitability status, and scientific research contribution. CONCLUSIONS: Through the performance analysis of different types of valuable medical equipment, a more real and comprehensive quantitative analysis is carried out, which plays a key role in the reasonable purchase, efficient operation and avoiding idling.

A Survey of Staff Training and Performance Management Practices: An Update.

The field of behavior analysis has experienced marked growth in the number of credentialed professionals over the last decade. This growth may have implications for the quality of staff training, performance management, and supervision practices provided in human service settings. The purpose of this survey was to extend DiGennaro Reed and Henley (2015) by surveying credentialed and aspiring behavior analytic professionals on the staff training, performance management, and supervision practices available at their current place of employment. Three main differences were observed in relation to the findings of DiGennaro Reed and Henley. The current findings indicate notable changes in the demographic characteristics of survey respondents. In addition, we observed modest increases in the use of best practices for initial and ongoing training and performance management. Results also indicate several areas of concern regarding the provision of supervisory skills training. • Results revealed improvements in the percentage of respondents who received initial or preservice training compared to DiGennaro Reed and Henley (2015). However, employers primarily rely on instructions and modeling to train their employees. • Findings revealed greater reliance on asynchronous and synchronous online training modalities compared to DiGennaro Reed and Henley (2015). • Results revealed a slight shift in the percentage of respondents who reported receiving ongoing training compared to DiGennaro Reed and Henley (2015). In the present study, BCaBAs and RBTs generally received ongoing training; however, fewer BCBAs reported receiving ongoing training. • The reported use of performance management practices improved compared to DiGennaro Reed and Henley (2015). That is, a higher percentage of respondents reported being observed at work while carrying out their job responsibilities. • Of the respondents who supervise staff, less than half of them reported receiving supervisory skills training. And only half of those respondents reported that their training prepared them to supervise others.

Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review.

BACKGROUND: Value-based healthcare (VBHC), which can be viewed as a strategy to organize and improve healthcare services, has far-reaching organizational and managerial consequences. It is common managerial practice to support the execution of a strategy by monitoring the ensuing activities. Such monitoring provides feedback and guidance on the execution of these activities to the management of an organization and helps to realize organizational strategies. Monitoring of activities is commonly done by performance management systems. Given the rising attention in the literature and in practice for VBHC, we ask to what extent VBHC is supported by performance management systems in practice, and how we can explain what we find to support further successful implementation of VBHC. METHODS: In our scoping review of financial and performance management at the organization or unit-level of healthcare organizations that apply value-based approaches, we identified 1267 unique papers in Embase, Medline, OVID, and Web of Science. After the (double-blinded) title and abstract screening, 398 full-text articles were assessed for further analysis. RESULTS: Our review reveals only eleven original papers discussing specifically the integration of VBHC and performance management systems. Almost all the featured applications in these papers focus on a specific project or medical specialty. Only one paper exemplifies how VBHC has been integrated with the performance management systems of a medical institution, and no paper provides a clear link with strategy execution. We ask why this is the case and propose several explanations by studying the extant performance management literature. We see these explanations as issues for further reflection for VBHC practitioners and researchers. CONCLUSION: We conclude that one of the reasons for the absence of papers integrating VBHC and performance management systems is formed by the tensions that exist between striving for "the best care" or even for providing "all care that is viably possible" and pursuing greater (financial) efficiency. Implementing VBHC as an important organizational strategy and explicating this strategy in the performance management systems requires that these tensions need to be brought into the fore. When this is not done, we believe that VBHC adoptions that are fully integrated with performance management systems will remain limited in practice.