Health-care process improvement decisions: a systems perspective.
OBJECTIVE
The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes.


METHODS
A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted.


RESULTS
The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations.


CONCLUSIONS
Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline.


CONCLUSIONS
Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.
Walley
Paul
P
University of Warwick, Coventry, UK. paul.walley@wbs.ac.uk
Silvester
Kate
K
Mountford
Shaun
S
D003659:Decision Making, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D004739:England; D006302:Health Services Research; D006740:Hospital Administrators; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D017146:Models, Organizational; D019982:Organizational Case Studies; D009936:Organizational Innovation; D017064:Process Assessment, Health Care; D012306:Risk; D013222:State Medicine / Q000458:organization & administration; D013597:Systems Analysis; D017749:Total Quality Management