Drifting Measures How performance measurement is perceived at different hierarchical levels of a public mental healthcare organization

Abstract

The demand for public healthcare services has increased rapidly over the last decades, which has entailed an amplified pressure on the healthcare organizations to increase the efficiency of care. In the 1980s, a wave of change usually referred to as New Public Management swept over the public sector and a number of private sector management techniques were implemented, including the concept of performance management. The traditional concept of financial performance measurement clashed against the intricate notions of good care, subsequently leading to the introduction of new performance measurement tools that included non-­‐financial performance measures. However, these tools were also adopted from the private sector and not tailored for the decentralized healthcare organizations with its many stakeholders and individuals of different professions. The decentralized healthcare organization is subject to the control complexities of action at a distance, where operating personnel might have difficulties in interpreting, understanding or personally rationalize the inscriptions inherent in specific accounting techniques supporting certain programs or objectives. Within public mental healthcare, the issues of performance measurement are even further enhanced due to the absence of objective outcome indicators, making the different users’ interpretations of performance measurement imperative to its result. Although there is substantial literature on the topic of management accounting within public healthcare in general and public mental healthcare in specific, there is a gap in the research of the interpretations and perceptions on account of the actors at different hierarchical levels within healthcare organizations regarding the purposes of given performance measures. Hence, in order to aid the further development of performance measurement within public mental healthcare, this study focuses on the role assigned to given performance measures by personnel at different hierarchical levels within a public mental healthcare organization, the reasons therefore and the consequences thereof. A qualitative case study conducted within the region of Västra Götaland, Sweden, illuminates the meaning of hierarchical communication, role perceptions, sense-­‐giving, accountability, stakeholder perspective, and cooperation in developing performance measures as shaping the perceptions of performance measures at different hierarchical levels.