Performance management of acute-care hospitals in HSE South

The experience of poor macroeconomic performance in the past has directed the Irish government towards new public management (NPM) in an attempt to reform public sector organisations and drive efficiency. More recently an economic boom has contributed to a changing population structure and facilitated greater funding of public sector organisations, particularly the health service. The literature shows that acute-care hospitals receive a substantial portion (38%) of the health service budget yet there are few studies involving performance management in this setting. This study explores the effect of NPM and the institutional environment on the development of performance management in an acute-care hospital setting. The study was based on three hospitals located in the Health Service Executive (HSE) South region. The primary research data was obtained from initial questionnaires and in-depth interviews with senior hospital management. Additional primary data was collected from in-depth interviews conducted with two senior HSE managers. Secondary data was gleaned from a range of documentary and other sources. The findings indicate that many of the aspects of NPM suggested in the literature were present and influential in directing health service reform. One of the most significant reform initiatives, the establishment of the HSE, has brought greater accountability and by improving information reporting, greater transparency and focus on hospital performance. A number of obstacles that may impinge on future reform were identified and in addition, research evidence suggests that change initiatives have produced some unexpected results. In relation to the institutional environment the findings suggest that this has also influenced the development of hospital performance management. There is evidence of legitimacy, the existence of rationalised myths and decoupling in the health service. The findings provide evidence of coercive, mimetic and normative isomorphism as hospitals comply with institutional pressures. The research indicates that there has been a shift in institutional logics whereby medical consultants are demonstrating greater interest in and engagement with hospital management and are facilitating a multi-disciplinary team approach to performance management. The study has added to the existing literature by demonstrating that NPM reform has influenced the Irish health service in both expected and unexpected ways. It also suggests that institutional theory provides a plausible explanation for the adoption of particular performance management practices. By eliciting the views and opinions of senior management members of an acute-care hospital the study has provided a unique insight into the issues and difficulties involved in monitoring performance on an ongoing basis