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Performance management in complex adaptive systems: a conceptual framework for health systems.

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Directive performance management in low- and middle-income countries often fails. Enabling approaches, leveraging intrinsic motivation and self-organization, show promise for improving health system outcomes. Context matters for balancing these strategies.

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Area of Science:

  • Health Systems Strengthening
  • Public Health Policy
  • Organizational Management

Background:

  • Current performance management in low- and middle-income countries (LMICs) is often directive and ineffective for improving health outcomes.
  • Existing frameworks lack the complexity to guide reforms in dynamic, multilevel health systems.
  • A need exists for contextually appropriate strategies balancing directive and enabling performance management approaches.

Purpose of the Study:

  • To present a novel framework for health system performance management situated within complex adaptive systems.
  • To identify interdependencies between organizational culture, software, system-level management, and the enabling environment.
  • To guide the selection of directive versus enabling approaches for improved organizational and system performance.

Main Methods:

  • Literature review across disciplines, synthesizing theoretical and empirical evidence.
  • Development of a conceptual framework integrating organizational and system-level performance management.
  • Analysis of interdependencies to inform the balance between directive and enabling strategies.

Main Results:

  • Performance management effectiveness depends on understanding complex interdependencies within health systems.
  • The framework highlights how organizational culture, software, and the enabling environment influence management approach suitability.
  • No universal blueprint exists; interventions require careful calibration to specific health system contexts.

Conclusions:

  • Strengthening health system performance management requires moving beyond purely directive methods.
  • A complex adaptive systems perspective is crucial for designing effective, context-specific performance management reforms.
  • Balancing directive and enabling approaches, informed by system interdependencies, is key to achieving better health outcomes.