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Performance Measurement Systems in Swedish Health Care Services
Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the quality management literature, measurements are attributed great importance in improving products and processes. Systems for performance measurement assessing financial and non-financial measurements were developed in the late 1980s and early 1990s. The research on performance measurement systems has mainly been focused on the design of different performance measurement systems. Many authors are occupied with the study of the constructs of measures and developing prescriptive models of performance measurement systems. There is a need in the research to shift focus from studying the construct of measurements to how they are used in real face-to-face situations in specific contexts.

The purpose of this thesis is to analyse the development, i.e. the design, implementation and use, of performance measurement systems in Swedish health care services. The study aims to increase the understanding of the role of performance measurement system in Swedish health care and thereby support health care improvements in general. Three research questions have been derived from the purpose. (1) How and why are performance measurement systems being developed in Swedish health care services? (2) What problems can be identified in the development? (3) What enabling factors can be identified in the development? A qualitative research strategy was selected for the research. The research is based on a multiple case study design conducted within two research projects. Information has been gathered through interviews, documents and observations.

The idea of performance measurement systems develops through several tracks when implemented in health care and the development follows a purposeful process of activities. The development was initiated when major changes occurred in the organisation or its environment. Performance measurement systems are primarily used to support a dialogue between management and employees regarding organisational improvement. Problems experienced are related to struggles to reach national consensus for measures, involving management, and the clarification of various end-users’ needs. Enabling factors are the frequent interaction with people developing the system, management’s involvement, the use of multi-skilled teams, and visual displays.

The research contributes to several insights to the research area of performance measurement system and health care practitioners. The research shows that the development process is far from straight forward and is formed by the influence of factors in the organisational context, which cannot always be predicted. By seeing the development as an innovation process, the focus is broadened from being technological towards the organisation as whole, which contribute to the existing research on performance measurement systems.

Place, publisher, year, edition, pages
Institutionen för ekonomisk och industriell utveckling , 2007. , 98 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1092Dissertations from the International Graduate School of Management and Industrial Engineering, ISSN 1402-0793 ; 108
Keyword [en]
Quality management, Health care, Performance measurement, Innovation management, Qualitative research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-9302ISBN: 978-91-85715-19-0 (print)OAI: oai:DiVA.org:liu-9302DiVA: diva2:23850
Public defence
2007-05-11, A2, Hus A, Campus Valla, Linköpings universitet, Linköping, 13:15 (English)
Opponent
Supervisors
Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2013-08-29
List of papers
1. Exploring the Use of Balanced Scorecards in Swedish Health Care Organizations
Open this publication in new window or tab >>Exploring the Use of Balanced Scorecards in Swedish Health Care Organizations
2004 (English)In: 7th International QMOD Conference, Monterrey, Mexico, 2004Conference paper, Published paper (Refereed)
Abstract [en]

Many Swedish health care organizations have during the last decade started implementing the Balanced Scorecard BSC as a systematic way of following-up and analyzing their activities. However, the knowledge of its use and contribution in a health care context is insufficient. Based on a multiple case study the authors explore the use of the BSC in the Swedish health care services. The authors conclude that the concept in a health care context is used as a quality management tool that make new demands on management. In addition, the authors bring out important factors for a long-term use of the BSC.

Keyword
performance measurements, balanced scorecard, visualization, case study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14566 (URN)
Available from: 2007-06-18 Created: 2007-06-18
2. Design and Implementation of a Performance Measurement System in Swedish Health Care Services: A Multiple Cases Study of 6 Development Teams
Open this publication in new window or tab >>Design and Implementation of a Performance Measurement System in Swedish Health Care Services: A Multiple Cases Study of 6 Development Teams
2005 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 14, no 2, 95-111 p.Article in journal (Refereed) Published
Abstract [en]

Performance measurement is considered to be an important part in improving and controlling contemporary organizations. Despite the increased interest in using and improving performance measurement systems, the number of researchers investigating the design and implementation process in more detail is still very small. The purpose of this article is to increase the understanding of how a performance measurement system, called the flow model, is designed and implemented by development teams in Swedish health care. The purpose of the flow model is to follow up the requirements in the National Care Guarantee through 8 measures. From a multiple case study of 6 local development teams, we conclude that the performance measurement system of the flow model is designed and implemented in Swedish County Councils through 3 development tracks, which are reflected in close interaction between the local development team and people in clinical departments. Enabling factors in the design and implementation are (1) the recognition of a need to change the current situation, (2) the teams' interaction with people in the clinical departments. (3) the national network meetings arranged by the financier. (4) the struggle to motivate and inform the top management, and (5) the establishment of contact with other development teams and ongoing projects.

Keyword
hospitals, medical care, county councils, public health, design and implementation, innovation management, performance measurement, quality assessment, waiting time measurement
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-14567 (URN)
Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-05-22
3. Measuring Lean Initiatives in Health Care Services: Issues and Findings
Open this publication in new window or tab >>Measuring Lean Initiatives in Health Care Services: Issues and Findings
2007 (English)In: International Journal of Productivity and Performance Management, ISSN 1741-0401, E-ISSN 1758-6658, Vol. 56, no 1, 7-24 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To discuss how a performance measurement system called 'the flow model' is designed to measure changes towards lean thinking in health care services.

Design/methodology/approach: Integrates literature from the health care sector and the lean production movement in order to understand whether lean thinking is applicable in healthcare and thereby identify key performance indicators that measure changes towards lean thinking in health care. The flow model is discussed in relation to this measurement framework.

Findings: Finds that lean thinking is applicable in health care settings, and that the flow model is a suitable tool for following up these initiatives. However, it is argued that the flow model needs to be balanced with other measurements in order to receive a complete picture of lean performance.

Research limitations/implications: Shows that the framework of measurements may be used in empirical research of assessing changes towards lean thinking in health care settings.

Practical implications: Shows that health care practitioners may use the findings to develop measurements of the outcome of lean initiatives on existing care processes.

Originality/value: Shows analysis and discussion of the application of an industrial concept - Lean Production - in health care services.

Keyword
Health services, Lean production, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-14568 (URN)10.1108/17410400710717064 (DOI)
Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2017-12-13
4. Goal Orientation and Conflicts: Motors of Change in Development Projects in Health Care Service
Open this publication in new window or tab >>Goal Orientation and Conflicts: Motors of Change in Development Projects in Health Care Service
2007 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 16, no 1, 84-97 p.Article in journal (Refereed) Published
Abstract [en]

The article presents parts of a larger research study which aims to explain how a process-oriented innovation unfolds and develops over time in the health care system in Sweden. It is said that local development teams have a rather broad notion of what it takes to implement the flow model. The theory used to explain the developmental patterns which have been identified in the national and local projects was presented.

Keyword
Case Study, change processes, innovation, Health care management, information technology, waiting time information
National Category
Medical and Health Sciences Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-14569 (URN)
Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-04-26
5. Challenges Experienced in the Development of Performance Measurement Systems in Swedish Health Care
Open this publication in new window or tab >>Challenges Experienced in the Development of Performance Measurement Systems in Swedish Health Care
2006 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 15, no 4, 244-256 p.Article in journal (Refereed) Published
Abstract [en]

The article discusses a study on the challenges faced by the Swedish health care industry in the development of performance measurement systems. The importance of performance measurement to the management of contemporary health care is explained. The need for the upper management to establish a quality council is also elaborated.

Keyword
health care industry, performance, medical care, caring, challenges, health care services, performance measurement system
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-14570 (URN)
Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-03-04

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