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RESEARCH PRODUCT

Overcoming traditional Performance Management in Public Healthcare Institutions: The need for a DPM Approach

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Donabedian (1988) was the scientific father of the notion that Performance Measurement (PM) of hospital outputs leads to improved quality of healthcare services, setting the foundations of how hospital quality is still today defined, considered and measured using three different kinds of measures: structure, process and outcome measures. Nonetheless, a growing part of literature during the last two decades has started doubting those favourable outcomes of PM on hospital quality (De Vos, et al., 2009; Nolan & Berwick, 2006; Werner et al., 2008a, 2008b; Werner & Bradlow, 2006; Wright & Hershman, 2014) while other research shows that ineffective PM systems are not just useless but potentially dangerous, able to substantially harm the organisation in many ways (Bianchi, 2010, 2012, 2015; Bivona & Montemaggiore, 2010; De Gooyert, Honingh & Van Genugten, 2019). Such trade-offs between desired and observed outcomes are well-known in the System Dynamics literature and could be used to explain common “pitfalls” of traditional PM systems in organisations. Surprisingly, there are not many studies targeting the pitfalls that are specifically encountered in hospitals or researching the potential harm of Donabedian-based hospital PM systems on the quality of healthcare services produced. Such studies would be necessary in order to address the gap in existing knowledge between the desired, favourable outcomes of PM on healthcare services quality and the observed, unfavourable ones (Bianchi, 2016; Bivona, 2013; De Gooyert et al., 2019; Forrester, 1958, 1961; Sterman, 1989, 2000). This theory-oriented research project addresses this gap by shedding light on how hospital quality is perceived by the relevant stakeholders and what mechanisms drive its dynamic behaviour. It tries to extend the Donabedian Model of Quality and build a more comprehensive Conceptual Model of hospital quality which will be able to encompass the feedback mechanisms between elements, that the Donabedian model fails to capture, and explain the short-term as well as the long-term dynamic impact of the PM measures on quality. Thus, a systemic and dynamic approach is needed in order to easily grasp causal relations and dynamics due to feedback, delays and non-linearities endogenous in the healthcare system, which co-determine hospital quality dynamics (Bianchi, 2016; Bivona & Cosenz, 2017a, 2017b; De Gooyert, 2018; Sterman, 2000).