title: Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations.
abstract: BACKGROUND
  Performance of health care systems is a key concern of policy makers and health service managers all over the world. It is also a major challenge, given its multidimensional nature that easily leads to conceptual and methodological confusion. This is reflected by a scarcity of models that comprehensively analyse health system performance.
  
  
  CONCLUSIONS
  In health, one of the most comprehensive performance frameworks was developed by the team of Leggat and Sicotte. Their framework integrates 4 key organisational functions (goal attainment, production, adaptation to the environment, and values and culture) and the tensions between these functions.We modified this framework to better fit the assessment of the performance of health organisations in the public service domain and propose an analytical strategy that takes it into the social complexity of health organisations. The resulting multipolar performance framework (MPF) is a meta-framework that facilitates the analysis of the relations and interactions between the multiple actors that influence the performance of health organisations.
  
  
  CONCLUSIONS
  Using the MPF in a dynamic reiterative mode not only helps managers to identify the bottlenecks that hamper performance, but also the unintended effects and feedback loops that emerge. Similarly, it helps policymakers and programme managers at central level to better anticipate the potential results and side effects of and required conditions for health policies and programmes and to steer their implementation accordingly.
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. bmarchal@itg.be.
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchal
authors.forename: Tom
authors.initials: T
authors.lastname: Hoerée
authors.forename: Valéria Campos
authors.initials: VC
authors.lastname: da Silveira
authors.forename: Sara
authors.initials: S
authors.lastname: Van Belle
authors.forename: Nuggehalli S
authors.initials: NS
authors.lastname: Prashanth
authors.forename: Guy
authors.initials: G
authors.lastname: Kegels
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D006296:Health Services; D006801:Humans; D011634:Public Health
references.citation: BMC Nurs. 2013 Mar 07;12:7
references.pmid: 23496961
references.citation: Health Serv Manage Res. 2009 Aug;22(3):101-14
references.pmid: 19633178
references.citation: Int J Integr Care. 2010 Dec 09;10:e117
references.pmid: 21289996
references.citation: Health Serv Manage Res. 1998 Feb;11(1):3-18; discussion 19-23
references.pmid: 10178369
references.citation: Health Serv Res. 2003 Jun;38(3):923-45
references.pmid: 12822919
references.citation: Rev Epidemiol Sante Publique. 2005 Sep;53 Spec No 1:1S22-30
references.pmid: 16327737
references.citation: Am J Med Qual. 2006 Nov-Dec;21(6):382-93
references.pmid: 17077420
references.citation: Health Aff (Millwood). 1992 Spring;11(1):84-107
references.pmid: 1577390
references.citation: Int J Health Plann Manage. 1995 Apr-Jun;10(2):113-28
references.pmid: 10144230
references.citation: J Health Serv Res Policy. 2003 Apr;8(2):105-17
references.pmid: 12820673
references.citation: Int J Health Plann Manage. 2003 Oct-Dec;18 Suppl 1:S79-88
references.pmid: 14661943
references.citation: Cad Saude Publica. 2004;20 Suppl 2:S268-82
references.pmid: 15608940
references.citation: Health Policy. 2013 Feb;109(2):150-7
references.pmid: 23201189
references.citation: Health Serv Res. 2002 Aug;37(4):1031-54
references.pmid: 12236382
references.citation: Brain Inj. 2010;24(6):812-22
references.pmid: 20433284
references.citation: Int J Qual Health Care. 2003 Oct;15(5):377-98
references.pmid: 14527982
references.citation: Lancet. 2005 Jul 9-15;366(9480):169-71
references.pmid: 16005341
references.citation: Health Policy Plan. 2000 Sep;15(3):239-46
references.pmid: 11012397
references.citation: BMJ. 2000 Nov 25;321(7272):1300-1
references.pmid: 11090498
references.citation: Cad Saude Publica. 2000 Jan-Mar;16(1):231-9
references.pmid: 10738168
references.citation: Harv Bus Rev. 2007 Nov;85(11):68-76, 149
references.pmid: 18159787
references.citation: Hosp Q. 2000 Summer;3(4):48-52
references.pmid: 11482269
references.citation: Health Serv Manage Res. 1998 Feb;11(1):24-41; discussion 41-8
references.pmid: 10178368
references.citation: Bull World Health Organ. 2000;78(6):740-50
references.pmid: 10916911
references.citation: Int J Health Plann Manage. 2012 Apr-Jun;27(2):104-29
references.pmid: 22302676
references.citation: Cad Saude Publica. 2009 Jul;25(7):1439-54
references.pmid: 19578565
references.citation: Int J Qual Health Care. 2008 Feb;20(1):47-52
references.pmid: 18024996
references.citation: Int J Health Plann Manage. 2003 Oct-Dec;18 Suppl 1:S27-39
references.pmid: 14661939
references.citation: Health Policy. 2008 Mar;85(3):263-76
references.pmid: 17931736
references.citation: Health Res Policy Syst. 2009 Oct 24;7:23
references.pmid: 19852834
references.citation: Health Serv Res. 2004 Aug;39(4 Pt 1):771-91
references.pmid: 15230927
references.citation: Soc Sci Med. 2014 Jan;101:107-12
references.pmid: 24560230
references.citation: Health Policy Plan. 1997 Sep;12(3):192-8
references.pmid: 10173400
references.citation: Am J Public Health. 2001 Aug;91(8):1235-9
references.pmid: 11499110
references.citation: BMC Public Health. 2010 Dec 24;10:787
references.pmid: 21184678
references.citation: Int J Qual Health Care. 2005 Dec;17(6):487-96
references.pmid: 16155049
references.citation: Health Policy. 2008 Jul;87(1):8-19
references.pmid: 18035448