Alignment Between Objective and Subjective Assessments of Health System Performance: Findings From a Mixed-Methods...

Area of Science:

• Health Services Research
• Organizational Behavior
• Healthcare Management

Background:

• Assessing health system performance is complex, involving both objective metrics and subjective executive perceptions.
• Discrepancies between subjective and objective performance evaluations may impact strategic decision-making and resource allocation.

Purpose of the Study:

• To evaluate the alignment between health system executives' subjective performance assessments and objective performance measures.
• To qualitatively explore factors contributing to high performance in healthcare organizations.

Main Methods:

• Interviews with 138 C-suite executives from 24 diverse health systems (2017-2019).
• Maximum variation sampling based on objective clinical performance.
• Thematic analysis of executive perceptions and identified drivers of high performance.

Main Results:

• Poor agreement (kappa = 0.082) was found between subjective and objective performance assessments, with executives generally rating their systems higher.
• Subjective assessments often prioritized market competition, financial performance, and customer satisfaction over clinical quality.
• Executives citing clinical quality metrics showed alignment between subjective and objective ratings.

Conclusions:

• Subjective performance assessments by executives may not accurately reflect objective performance, particularly when clinical quality is not the primary focus.
• Organizational culture, governance, and staff engagement are key levers for achieving high health system performance.
• Further research is needed on incorporating subjective assessments into value-based payment models.