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Lessons from mandated implementation of a performance management system.

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Summary

Implementing lean-inspired performance management systems in public healthcare requires clarity on managerial philosophy and technical aspects. Successful adoption depends on adapting these tools to the specific organizational context for better outcomes.

Keywords:
Health services sectorImplementationManagementOrganizational changePerformance management systemsPublic sector organizations

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Area of Science:

  • Healthcare Management
  • Organizational Behavior
  • Public Health Policy

Background:

  • Lean-inspired approaches and performance management systems are increasingly adopted in public healthcare globally.
  • Existing literature shows mixed results on the benefits of these management tools.
  • There is a significant knowledge gap regarding the large-scale implementation processes of these systems.

Purpose of the Study:

  • To describe the implementation process of mandated performance management systems in public healthcare.
  • To analyze how the implementation process influences the mandated system.
  • To understand factors affecting the successful adoption of these tools.

Main Methods:

  • Comparative case study of three Canadian healthcare organizations.
  • Data collection through document analysis, non-participant observation, and semi-structured interviews (n=30).
  • Sociotechnical approach analyzing organizational context, technical substrate, theory of action, and managerial philosophy.

Main Results:

  • Despite a national mandate, the implemented performance management tools varied significantly across organizations.
  • Variations were attributed to the flexibility of the technical substrate, unclear managerial philosophy, and contextual factors.
  • Successful implementation appears linked to high hybridization of the tool across dimensions, not just a prescribed technical substrate.

Conclusions:

  • Mandated implementation is more successful when managerial philosophy, technical substrate, and their linkage are explicit.
  • Allowing flexibility for adaptation to organizational context is crucial for successful implementation.
  • This study offers insights into the process of mandated, large-scale performance management system implementation in public healthcare.