Performance Regimes in Health Care: Institutions, Critical Junctures and the Logic of Escalation in England and the Netherlands

Abstract

The Netherlands and England are near neighbours whose health care systems have much in common and whose health policy communities have also usually been well aware of what is going on in the other country. Nevertheless, for the two decades from 1982, England adopted and repeatedly redeveloped performance indicator (PI) systems in the health care field while the Netherlands virtually shunned them. A broad institutional explanation for this divergence is provided by England's majoritarian and adversarial political system that leaves governments with fewer constraints and compromises than in the more consociational Dutch system. More recently, however, a Dutch national system of health care PIs has appeared, suggesting that this explanation needs to be supplemented. This paper draws on an empirical study of PI systems in the two countries over the period from 1982 to 2007 to suggest that two further factors are at work. Established institutional patterns may be disrupted by 'punctuations', while technical and political factors endogenous to PI systems may exert a logic of their own.

Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals

“…Our findings suggest that in a healthcare context, a formative and cross-functional orientation supports this, by encouraging all those involved in a work process to come together to address performance concerns. This finding contributes to addressing mixed evidence regarding the effects of performance management in healthcare (Pollitt, Harrison, Dowswell, Jerak-Zuiderent and Bal, 2010), as well as tensions in the literature between 'control' and 'commitment' HR practices (Reed 2010). It does so by suggesting that 'control' practices can have mutually beneficial outcomes for both individuals and organisations, where applied in a constructive manner, and in an environment that aims to diffuse blame and encourage problem-solving and improvement (c.f.…”

“…Performance management has yielded mixed effects in healthcare (Pollitt, Harrison, Dowswell, Jerak-Zuiderent and Bal, 2010). This has been attributed to its potential to undermine the collective pursuit of shared goals (Walburg, 2006), despite recognised potential for OPMS to support goal-oriented dialogue and behaviour (De Haas and Kleingeld 1999).…”

When will we ever learn ?

“…As a result, PIs might turn out to be too narrow, as only that which can be agreed on is covered by the indicators (Van Th iel and Leeuw 2002; Ordóñez et al 2009), or too wide, when diff erent interpretations are encompassed in order to reach a consensus or manage uncertainty about causal conjunctions (Pollitt et al 2010). Too few indicators have the tendency to foster goal displacement through knowledge about how judgments are made (Pidd 2005;Frey et al 2013), while too many indicators tend to be too challenging and therefore tend to make the model ineffi cient and undermine ambitions (de Bruijn 2002;Frey et al 2013).…”

Events, Public Discourses and Responsive Government: Quality Assurance in Health Care in England, Sweden and Japan

“…It has also highlighted the dilemma in the politics of quality assurance system-building of choosing between satisfying public demands and respecting scientific expertise. In other words, the macro political environment matters to the development of such systems (Pollitt et al 2010). …”