Performance management and accountability in health care – MAD, crowding out or fruitful redundancy?

The adoption of performance management tools in health care is currently seen as a major opportunity to realize public values such as efficiency, effectiveness, equity and quality. However, there is also a dark side of... [ view full abstract ]

The adoption of performance management tools in health care is currently seen as a major opportunity to realize public values such as efficiency, effectiveness, equity and quality. However, there is also a dark side of performance management: Multiple Accountability Dis-order (MAD) has been identified as one of the potential dysfunctional consequences of the boom in performance management schemes for health care (Koppell 2005). Organizations suffering from MAD “oscillate between behaviours consistent with conflicting notions of accountability”. The organizations will seek to please different stakeholders and accountability forums, and thereby ironically may lose focus of the development potential of collecting and processing performance information. MAD is serious and can be seen as a consequence of the broader condition of “measurementitis” (Pollitt 2010), which has affected health care systems widely. This condition has been associated with a number of other potentially negative effects, and MAD is only one in a family of other accountability diseases including “increased transaction and opportunity costs”, “negativity focus rather than improvement”, “blame games”, “loss of control” and “symbolic accountability” (Schillemans and Bovens 2010).
The aim of this paper is to analyze recent developments in performance management regimes for health care in three Northern European countries – UK, Denmark, and Germany - and to facilitate a discussion about the potential consequences of the way these performance regimes are designed. We will investigate the multiplicity of accountability relations using empirical material from expert interviews and policy document analysis. Our guiding research question is whether the coexistence of different accountability forms lead to dysfunctions or can indeed present a happy family of different diagnostic tools, serving different purposes or even reinforcing each other in a beneficial “redundancy” as suggested by Schillemans and Bovens (Schillemans and Bovens 2010)?


References
Koppell, Jonathan GS. 2005. “Pathologies of Accountability: ICANN and the Challenge of ‘Multiple Accountabilities Disorder.’” Public Administration Review 65(1): 94–108.

Pollitt, Christopher. 2010. “Performance Blight and Tyyranny of Light? Accountability in Advanced Performance Measurement Regimes.” In Accountable Governance: Problems and Promises, eds. Melvin J. Dubnick and H. George Frederickson. M.E. Sharpe, 81–97.

Schillemans, Thomas, and Mark Bovens. 2010. “The Challenge of Multiple Accountability: Does Redundancy Lead to Overload?” In Accountable Governance: Problems and Promises, eds. Melvin J. Dubnick and H. George Frederickson. M.E. Sharpe, 3–21.