Quality improvement or symbolic adoption: mandating performance measurement in local public health

Performance management has gained significant momentum throughout the public sector in recent decades. A large share of public organizations claim to have adopted some form of performance system that involves the collection and use of operational information to inform managerial decision-making. This is particularly true in public health. The growth in popularity of quality improvement initiatives and PHAB accreditation have led to a boom in performance adoption. However, the study of performance in public health has lagged behind the practice. This study examines performance management in public health via three independent yet connected studies. The first is an in-depth, qualitative case study of a mandated performance measurement system in the U.S. state of New Jersey. The study suggests that a centralized system of performance data collection require the active participation of the aggregating body to analyze and disseminate the information back to the reporting agencies. The second and third studies take this finding, a need for a robust performance information reporting framework, and evaluate two potential weaknesses in the communication of performance information. Through an experimental framework, the visual display of performance information is examined as well as bureaucratic susceptibility to framing effects data reporting are evaluated. These studies find that for more complex key performance indicators, bureaucrats attach more value to graphically displayed information. Additionally, they exhibit sensitivity to framing effects, information presented in a positive frame is received more positively and vice versa for negatively framed information. The findings of this study will contribute to the ongoing efforts of New Jersey and other states to develop meaningful and effective systems of performance management that will not only improve operational efficiency but indeed the overall health of the public.Ph.D.Includes bibliographical referencesby Andrew Ballar