title: Challenges experienced in the development of performance measurement systems in Swedish health care.
abstract: OBJECTIVE
  The purpose of this article is to investigate challenges experienced in the development of a performance measurement system in Swedish health care services.
  
  
  METHODS
  We conducted case studies in 6 development projects focusing on the development of a common model for waiting time measurement in Swedish health care services. We studied the cases during a 2-year period using interviews, observations, and documents as information sources.
  
  
  RESULTS
  The findings reveal that many of the projects' challenges are not unique, but common to the entire development process. The 4 challenges identified were (1) reaching national consensus when developing performance measurement systems in a local context, (2) maintaining competence in a wide range of fields in the project team for an extended time period, (3) accepting scrutiny of the project by top management even when it conflicts with other assigners' requirements, and (4) clarifying the various end users and distinguishing between their different needs.
  
  
  CONCLUSIONS
  We conclude that management needs a common understanding of measures and related terms and should discuss these continuously during the development process. We also suggest that upper management create a clear structure and keep each project's individual requisites in mind while working on multiskilled projects. Finally, we conclude that a difficult challenge for a project team developing performance measurement systems is answering the question: Who is end user?
authors.affiliation: Division of Quality Technology and Management, Linköping University, Linköping, Sweden. beako@ikp.liu.se
authors.forename: Beata
authors.initials: B
authors.lastname: Kollberg
authors.forename: Mattias
authors.initials: M
authors.lastname: Elg
mesh_terms: D017598:Efficiency, Organizational; D007407:Interviews as Topic; D019982:Organizational Case Studies; D012107:Research Design; D013222:State Medicine / Q000458:organization & administration / Q000592:standards*; D013548:Sweden