Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE credits
Appropriate choice of performance measurement system (PMS) is the key to ensure that proper initiatives have been taken in the right regard to implement the policy that has been set for achieving the overall organizational goal that is to serve best interest of all stakeholders. In the context of public organization especially in health sector, choice of PMS has evolved quite significantly in order to respond to the demand of improving quality. In the bid of improving quality, healthcare sector has gone through several reforms, previous investigations are mainly concentrated towards examining process involved in designing different form of measurement system but study concerning critical attitude towards challenges of implementation of performance measurement are still few in numbers. Considering both economic and social impact it is a matter of great urgency to investigate further into the issue so that healthcare organizations can make sure the best utilization of available measurement systems, in order enhance quality of healthcare.
The main aim of this study to understand the research gap concerning implementation related challenges and effectiveness of performance measurement system which are currently in place in context of Värmland county council healthcare organization.
A qualitative research method has been prioritized for current study and among available alternatives case study approach through interview was considered more appropriate. The idea behind the interviews was an attempt to listen to people representing different units that would help to answer research questions and providing broader perspective for the critical analysis of the research outcome in the light of available theoretical framework.
The result shows that in Värmland county council policy makers have adopted a combination of Balanced Scorecard (BSC) and Lean as a performance measurement tool. Challenges faced cover areas like as an origin of nonfinancial measurement system BSC was unable to measure activity based performance and the process of making it fit to cover client or patient perspective because in case of healthcare stakeholder group is quite diverse. In addition to integrate other available perspective and make into a fit with overall organizational strategy due to non-profit making nature is also quite hectic. Convincing particular key line and middle managers in favor of new measurement adoption is very expensive both in terms of time and cost associated with it. Diverse interpretations of quality book also other major challenges that received greater attention during the implementation phase.
In addition, the bottom up approach of Lean at times creates higher difficulty for the healthcare professional that holds specific level of autonomy in their service delivery process due to their knowledge and professional expertise. Another major issue is the resource scarcity in terms of specialist doctors which makes it extremely complex to fully adopt and implement measurement model in the scope of healthcare which is originally initiated for the private and profit oriented organization, thus higher waiting time is significantly resulting in decline of service quality. The fixed payment structure that is currently in place in county council which is another major area of concern that is making the measurement of quality and implementation measurement model much difficult to apply which might be much easier in case of outcome based payment structure.
It is obvious to point finger towards the fact, why healthcare sectors are trying to adopt BSC and lean in their organizational setting if they are exposed to so many implementation hazards? One of the logical reasoning in this regard is that despite all the difficulties these measurement systems are facilitating quite positive impacts in context of healthcare to improve service quality, providing the understanding to develop a culture that would help everyone to understand their role in reaching overall organizational goal and stood up in case of encountering any deviations, that culture would ultimately lead towards a more sustainable healthcare in the long-run.
Keywords: Performance measurement system, challenges of implementation, balanced scorecard, lean, quality of healthcare.
2016. , 85 p.