Key forces compelling the monitoring of hospital performance: An exploratory study

Abstract

Performance management in the public sector is both multifaceted and convoluted. This is particularly pertinent in hospitals, which are complex institutional organizations. Our paper explores the key drivers compelling Irish public acute-care hospitals to monitor their performance. The context of our study is located against the unique historical backdrop of the Irish health service, whose evolution over time reflects religious control, underfunding by the State and reliance on a decentralized structure up until the early 2000s. This study was conducted during 2009–2010, in the aftermath of the financial crisis of 2008–2009. Interviews were conducted with members of the hospital executive management team, comprising clinical and nonclinical senior managers, using the framework of Kelly et al. (2015) to explore and analyze respondent perspectives. We propose that a combination of key forces, emanating from new public management, the institutional environment, and its constituent elements spurs hospitals to monitor their performance. The confluence of these forces reveals a perceived change in the institutional logic underpinning hospital performance management. This change involved the substitution of autonomous clinical decision-making for a more team-based managerial logic whereby clinicians engaged as part of a multidisciplinary executive unit and accepted responsibility for hospital performance. This paper contributes to the literature on performance management in public services and, more specifically, builds on and addresses the paucity of research on Irish acute-care hospitals.