The Performance Management Design in Public Hospitals: A Case Study

In response to the growing pressure on public budgets, many countries introduced various private-sector-inspired management practices to improve the performance of publicly funded health systems. Regardless, the non-negligible share of health-care spending is still considered wasteful, and the search for efficiency gains in healthcare is still relevant. The relevance even increases in the context of events related to the outbreak of the coronavirus disease in 2020, presenting new challenges for performance management in hospitals. Considering the gaps between the environmental settings of various countries, a finding of one universal theory of effective hospital management is unlikely. The contextual examination of hospital management on the national level and knowledge-sharing is then a more suitable approach to aid the practitioners in search of the most appropriate mix of management practices.

This study employed a mixed methodological approach to examine individual aspects of performance management from the hospital management’s perspective to identify the areas of potential efficiency gains. The core research phase consisted of on-site visits in three public hospitals taking place since September 2019 with the respondents from various management levels and both clinicians and non-clinicians. During an approximately hour-long session the respondents were asked to fill out the questionnaire examining the aspects of the performance management system employed in their institution (e.g., the scope of measurement, reliability of data, communication of results, engagement of management) and interviewed to examine the rationale of provided responses. The on-site research stage resulted in 87 complete data sets further analyzed using statistical analysis with results interpreted using commentaries and rationales obtained from interviews.

The findings were similar among all examined institutions and mostly consistent with similarly natured studies. While the performance measurement appeared to reflect the clinical performance better than the organizational one, it is also perceived as inadequate to the complexity of service. The management seemed to consider performance management for operational purposes rather than being incentive-oriented or exploratory, in line with the perceived lack of connection between the performance measurement and the organizational strategy. Combined with poor communication of performance management principles, this discrepancy appears to contribute to the potential tension between the hospital and clinical management in setting priorities between the economic performance and the quality of care. Overall, these findings should provide insight into aspects influencing performance management employed in public hospitals in the Czech Republic and present the evidence for the discussion of potential efficiency gains in practice.