The Ambiguous Impact of Performance Measurement on Service Quality

Abstract

BackgroundPerformance measurement is growing in importance as a management tool in services for disabled people.AimThe aim of this article is to add to the existing literature by exploring (a) the motivation for the introduction of such measurements, (b) the reasoning behind the choice of current indicators, and (c) the impact of performance measurements on service delivery.Methods(1) A study of documents (national and, if available, also local) on the motivation for, choice of, and implementation of quality measurements, and (2) interviews with top and middle managers in community services for people with intellectual disabilities or mental health difficulties.ResultsA varied set of motivations have been identified, including the intention to introduce a more facts-based and transparent governance, the need for information that supports the management of scarce resources, and as a tool in the development of service quality for users. The motivation appears to be dependent on level of government, and the attitude among service unit managers tends to be ambivalent; they want performance measurements but cannot see how to measure the important aspects of service quality. The choice of actual indicators is subject to a process bias; that is, one measures what is easily available in administrative systems. The results concerning impact on services are less clear and also context dependent. We have identified usage in the search for cost-cutting possibilities, defense against critique, and that reporting runs the risk of reinforcing routinization of services.DiscussionThe possible impact on services is discussed. Layers of ambiguity are outlined, as measurements can be tools both for quality development and in the defense of current services against “unrealistic demands” from the media or stakeholders. The measurements tend to be used more as sources of governance information than tools for quality development.ConclusionThe impact of quality measurement is rather ambiguous. On the one hand, it functions as a tool for budget control, whereas on the other hand, unit managers call for better measurement of user outcomes and expect that such measurement can balance the current preoccupation with input indicators, such as expenditures.

Introduction: The Need for Implementing a Digital Welfare Critique From an Assemblage Analytical Approach

“…The origin of the current institutional vocabulary of 'quality' is clearly traceable from the 1990s and the then emerging ways of knowing regulations and standards for quality systems. Tøssebro et al (2022) explain that while many countries introduced performance measurements with QI in response to the marketisation of services, this was slightly different in Norway, and in some cases linked to an implemented purchaser-provider split. Tøssebro (2019) also links the introduction to a general shift that simultaneously took place, from a social-policy reasoning that focused on living conditions to a reasoning that addressed the role of quality issues in the internal control systems that then became mandatory in health and care services.…”

“…However, the emphasis quickly shifted to procedures to ensure quality, and quality was redefined as quality development. After 2000, the approach of the national government gradually transitioned away from a more reflective process and assumed a measurement orientation, and quality indicators emerged as a topic in national policy (Tøssebro et al, 2022). The development of professional quality registers came into focus, and quality indicators became a part of a national strategy for quality improvement in the public sector.…”

“…Arguments against QI and performance measurement point out the risk of goal displacement, tunnel vision, target fixation, and process bias -that one tends to measure what is easily measured (see Tøssebro et al (2022) for a discussion of performance management in Norwegian services for disabled people, including a summary of these arguments. See also Bruijn (2007) for an extensive critique of performance measurement systems in practice).…”

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“…Arguments against QI and performance measurement point out the risk of goal displacement, tunnel vision, target fixation, and process bias -that one tends to measure what is easily measured (see Tøssebro et al (2022) for a discussion of performance management in Norwegian services for disabled people, including a summary of these arguments. See also Bruijn (2007) for an extensive critique of performance measurement systems in practice).…”

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“…Arguments against QI and performance measurement point out the risk of goal displacement, tunnel vision, target fixation, and process bias -that one tends to measure what is easily measured (see Tøssebro et al (2022) for a discussion of performance management in Norwegian services for disabled people, including a summary of these arguments. See also Bruijn (2007) for an extensive critique of performance measurement systems in practice).…”