Skip to main content

Performance Measurement as the Basis for Hospitals Strategic Management

  • Conference paper
  • First Online:
Country Experiences in Economic Development, Management and Entrepreneurship

Abstract

Hospitals are institutions of very high degree of complexity and they absorb significant budgetary resources. Effective management is very important for hospitals and for society as a whole. In conditions of limited financial resources, management of hospitals is extremely complex and demanding, and requires the use of high quality and timely management information. Authors analyze what information managers of public hospitals need for successful, balanced management. The aim is to explore issues of performance measurement as a basis for strategic business management of Croatian hospitals. Hospitals are under pressure to provide high quality services, while in the same time, they need to reduce costs, improve performance and increase customer satisfaction. Information on costs, prices and service fees, program goals, methods of measuring programs’ performance, financial and non-financial performance indicators are therefore extremely important for strategic business management of hospitals. This paper analyzes the ways of measuring hospital’s performance, the selection and definition of adequate performance indicators, and models of performance reports as a basis for business decisions making and the presentation of performance. Based on the analysis we propose performance report for one hospital in Croatia, a methodology of drafting the report as well as its use in decision-making process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alexander, J. A., Weiner, B. J., & Griffith, J. (2006). Quality improvement and hospital financial performance. Journal of Organizational Behaviour, 27, 1003–1029.

    Article  Google Scholar 

  • Attfield, S., & Adams, A. (2006). Patient information needs: Before and after doctor consultations. Health Informatics Journal, 12(2), 165–177.

    Article  Google Scholar 

  • Barliba, I. (2012). Relevance of Key Performance Indicators (KPIs) in a hospital performance management model. Journal of Eastern Europe Research in Business & Economics, Retrieved February 17, 2015, from http://www.ibimapublishing.com/journals/JEERBE/2012/674169/674169.pdf

  • Boyce, J., Dixon, A., Fasolo, B., & Reutskaja, E. (2010). Choosing a high-quality hospital: The role of nudges, scorecard design and information. London: The King’s Fund.

    Google Scholar 

  • Brigl, B., Ammenwerth, E., Dujat, C., Gräber, S., Grosse, A., Häber, A., et al. (2005). Preparing strategic information management plans for hospitals: A practical guideline SIM plans for hospitals: A guideline. International Journal of Medical Informatics, 74(1), 51–65.

    Article  Google Scholar 

  • Budimir, V. (2011). Računovodstvene informacije i mjerenjeuspješnosti u funkciji upravljanja proračunskih korisnika [The accounting information and performance measurement in function of budgetary users’ management]. Ph. D. Ekonomski fakultet.

    Google Scholar 

  • Burnett, S., Renz, A., Wiig, S., Fernandes, A., Weggelaar, A. M., Calltorp, J., et al. (2013). Prospects for comparing European hospitals in terms of quality and safety: Lessons from a comparative study in five countries. International Journal for Quality in Health Care, 25(1), 1–7.

    Article  Google Scholar 

  • Caballer-Tarazona, M., Moya-Clemente, I., Vivas-Consuelo, D., & Barrachina-Martínez, I. (2010). A model to measure the efficiency of hospital performance, mathematical and computer modelling. Elsevier, 52, 1095–1102.

    Google Scholar 

  • Caldwell, D. F., Chatman, J., O’Reilly, C. A., 3rd, Ormiston, M., & Lapiz, M. (2008). Implementing strategic change in a health care system: The importance of leadership and change readiness. Health Care Manage Review, 33(2), 124–133.

    Article  Google Scholar 

  • Cercone, J., & O’Brien, L. (2010). Benchmarking hospital performance in health, Sanigest international. Retrieved August 14, 2015, from http://www.scribd.com/doc/254036336/Benchmarking-Hospital-Performance-in-Health#scribd

  • Chesterfield Royal Hospital (CRH). (2014). Performance center. Retrieved February 22, 2015, from https://www.chesterfieldroyal.nhs.uk/about/perf-centre/index?_ts=1

  • Christiaens, J., & Rommel, J. (2008). Accrual accounting reforms: Only in businesslike (parts of) governments. Financial Accountability & Management, 24(1), 59–75.

    Article  Google Scholar 

  • CIHI (Canadian Institute for Health Information). (2013). Health indicators 2013. Ottawa: CIHI.

    Google Scholar 

  • CIHI (Canadian Institute for Health Information). (2014). Canadian MIS database: Hospital financial performance indicators, 2008–2009 to 2012–2013—Methodological notes. Ottawa: CIHI.

    Google Scholar 

  • Dan, S. (2015). Governed or self-governed? The challenge of coordination in European public hospital systems. Leuven: FaculteitSocialeWetenschappen—Onderzoekseenheid: Instituutvoor de Overheid.

    Google Scholar 

  • Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748.

    Article  Google Scholar 

  • Dye, C., Boerma, T., Evans, D., Harries, A., Lienhardt, C., McManus, J., et al. (2013). Research for universal health coverage. Luxembourg: WHO.

    Google Scholar 

  • Fahlevi, H. (2014). The innovation of the role of accounting in public hospitals—Lessons learned from hospital financing reforms in Indonesia and Germany. Ph. D. der Deutschen Universität für Verwaltungs Wissenschaften Speyer.

    Google Scholar 

  • Finkler, S. A., & Ward, D. M. (1999). Cost accounting for health care organizations: Concepts and applications (2nd ed.). Gaithersburg: Aspen.

    Google Scholar 

  • Gapenski, L. C. (1999). Healthcare finance: An introduction to accounting and financial management. Ann Arbor, MI: Michigan University: Health Administration Press.

    Google Scholar 

  • Gopal, R., & Badi, S. S. (2014). Impact of hospital services on outpatient satisfaction. IMPACT: International Journal of Research in Business Management, 2(4), 37–44.

    Google Scholar 

  • Groene, O., Skau, J. K., & Frølich, A. (2008). An international review of projects on hospital performance assessment. International Journal for Quality in Health Care, 20(3), 162–171.

    Article  Google Scholar 

  • Gruening, G. (2001). Origin and theoretical basis of new public management. International Public Management Journal, 4, 1–25.

    Article  Google Scholar 

  • Hafner, J. M. (2011). The perceived impact of public reporting hospital performance data: Interviews with hospital staff. International Journal for Quality in Health Care, 23(6), 697–704.

    Article  Google Scholar 

  • Haque, M. S. (2004). New public management: Origins, dimensions, and critical implications. In K. K. Tummala (Ed.), Public administration and public policy (pp. 209–229). Oxford: Eolss.

    Google Scholar 

  • Heine, R. P., & Maddox, E. N. (2010). Hospital management reform: A step to healthcare reform. Journal of Management and Marketing Research, 5, 1–7.

    Google Scholar 

  • Hood, C. (1995). Contemporary public management: A new global paradigm? Public Policy and Administration, 10(2), 104–117.

    Article  Google Scholar 

  • Hrvatski zavod za zdravstveno osiguranje (HZZO) [Croatian Health Insurance Fund (CHIF)]. (2014). Pokazatelji rada bolnica [Indicators of hospital work]. Retrieved August 21, 2015, from http://www.hzzo.hr/hzzo-predstavio-pokazatelje-kvalitete-i-ucinkovitosti-za-bolnicke-zdravstvene-ustanove

  • Hrvatski zavod za zdravstveno osiguranje (HZZO) [Croatian Health Insurance Fund (CHIF)]. (2015). Financiranje zdravstvene zaštite [The financing of health care]. Retrieved August 26, 2015, from http://www.hzzo.hr/zdravstveni-sustav-rh/financiranje-zdravstvene-zastite/

  • Hrvatski zavod za zdravstveno osiguranje (HZZO) [Croatian Health Insurance Fund (CHIF)]. (2015). Tablice pokazatelja poslovanja zdravstvenih ustanova [Tables of health institutions performance indicators]. Retrieved September 09, 2015, from http://www.hzzo.hr/hzzo-za-partnere/prikupljanje-financijskih-izvjesca-ustanova-u-zdravstvu/

  • Hurst, J., & Jee-Hughes, M. (2001). Performance measurement and performance management in OECD health systems. OECD Labour Market and Social Policy Occasional Papers, No. 47. Paris: OECD.

    Google Scholar 

  • International Federation of Accountants (IFAC). (2001). Study 13: Governance in the public sector: A governing body perspective. New York: IFAC, Public Sector Committee.

    Google Scholar 

  • Jakir Bajo, I. (2014). Promjene u načinu planiranja i izvršavanja financijskih planova ustanova u zdravstvu [Changes in planning and execution of financial plans in health care institutions]. TIM4PIN, 2(12), 105–109.

    Google Scholar 

  • Jewish General Hospital (JGH). (2015). Quality indicators. Retrieved September 24, 2015, from http://jgh.ca/en/qualityBackground?mid=ctl00_LeftMenu_ctl00_TheMenu-menuItem001

  • Kaissi, A. A. (2008). Strategic planning process and hospital financial performance. Journal of Health Management, 53(3), 197–209.

    Google Scholar 

  • Kanižaj, T. (2006). Model uravnotežene tablice rezultata za upravljanje izvedbom projekta [Model of a balanced result table for project performance management]. Master Thesis, Ekonomski fakultet.

    Google Scholar 

  • Kaplan, R. S., & Norton, D. P. (1996). Using the balanced scorecard as a strategic management system. Harvard Business Review, 74(1), 75–85.

    Google Scholar 

  • Katić, B., & Vidović, J. (2012). Nedostatci primjene proračunskog računovodstva u zdravstvenim ustanovama—primjer Opće bolnice Zadar [The disadvantages of the application of budgetary accounting in health care institutions—e.g. General Hospital Zadar]. Ekonomska misao i praksa [Economic thought and practice], 21(2), 777–794.

    Google Scholar 

  • Kaya, S. D., Ilery, Y. Y., & Yuceler, A. (2014). Importance of hospital way-finding system on patient satisfaction. In: Business Challenges in the Changing Economic Landscape—Vol. 2. Proceedings of the 14th Eurasia Business and Economics Society Conference, October 23–25, 2014, Barcelona, Spain, pp. 33–40.

    Google Scholar 

  • Kelley, E., & Hurst, J. (2006). Health care quality indicators project: Conceptual framework paper. OECD. Retrieved August 25, 2015, from http://www.oecd.org/els/health-systems/36262363.pdf

  • Kovač, N. (2013). Financiranje zdravstva—situacija u Hrvatskoj [Financing health care—The situation in Croatia]. Ekonomski vjesnik [Econviews: Review of Contemporary Business, Entrepreneurship and Economic Issues], 26(2), 551–563.

    Google Scholar 

  • Larbi, G. A. (1999). The new public management approach and crisis states. UNRISD Discussion Paper No. 112. Geneva: United Nations Research Institute for Social Development.

    Google Scholar 

  • Lee, S., & Alexander, J. (1999). Consequences of organization change in U.S. hospitals. Medical Care Research and Review, 56(3), 227–276.

    Article  Google Scholar 

  • Loeb, J. M. (2004). The current state of performance measurement in health care. International Journal for Quality in Health Care, 16(1), i5–i9.

    Article  Google Scholar 

  • McIntyre, D., Rogers, L., & Heier, E. J. (2001). Overview, history, and objectives of performance measurement. Health Care Financing Review, 22(3), 7–21.

    Google Scholar 

  • Mettler, T., & Rohner, P. (2009). Performance management in health care: The past, the present, and the future. In: 9th International Conference on Business Informatics “Business Services: Concepts, Technologies and Applications”, 25–27 February 2009, Vienna, Austria.

    Google Scholar 

  • Meyer, J. A., Silow-Carroll, S., Kutyla, T., Stepnick, L. S., & Rybowski, L. R. (2004). Hospital quality: Ingredients for success—Overview and lessons learned. The Commonwealth Fund. Retrieved August 21, 2015, from http://www.commonwealthfund.org/programs/quality/761_Meyer_hospital_quality_overview.pdf

  • National Health Performance Authority (NHPA). (2014). Performance indicator reporting. NHPA. Retrieved August 21, 2015, from http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Performance-Indicator-Reporting

  • Nerenz, D. R., & Neil, N. (2001). Performance measures for health care systems. Commissioned Paper for the Center for Health Management Research. Retrieved February 10, 2015, from www.hret.org/chmr/resources/cp19b.pdf

  • Nikjoo, R. G., Beyrami, H. J., Jannati, A., & Jaafarabadi, M. A. (2013). Selecting hospital’s key performance indicators, using analytic hierarchy process technique. Journal of Community Health Research, 2(1), 30–38.

    Google Scholar 

  • Northcott, D., & Llewellyn, S. (2004). The balancing act in hospital performance measurement: A comparison of UK and New Zealand approaches. Research executive summaries series, 5(2). Retrieved August 25, 2015, from http://www.cimaglobal.com/Documents/ImportedDocuments/cid_ressum_the_balancing_act_in_hospital_performance_measurement_mar09.pdf

  • Nyland, R., & Pettersen, I. J. (2004). Performance management and measurement concepts for better management control in public hospitals? A study of the hospital sector in Norway. Oslo: Health Organization Research Norway—HORN, Working paper 2004: 5.

    Google Scholar 

  • Ocampo, R. B. (2000). Models of public administration reform: “New public management (NPM)”. Asian Review of Public Administration, 12(1), 248–255.

    Google Scholar 

  • Ott, K., Bajo, A., Bronić, M., Bratić, V., & Medak Fell, D. (2009). Proračunski vodič za građane; drugo, promijenjeno izdanje [Budget guide for citizens; second, revised edition]. Zagreb: Institut za javne financije, Zaklada Friedrich Ebert [Institute of Public Finance, Foundation Friedrich Ebert].

    Google Scholar 

  • Peltier, J., Dahl. A., & Mulhern, F. (2009). The relationship between employee satisfaction and hospital patient experiences. Forum for People Performance Management and Measurement. Retrieved August 21, 2015, from http://www.info-now.com/typo3conf/ext/p2wlib/pi1/press2web/html/userimg/FORUM/Hospital%20Study%20-Relationship%20Btwn%20Emp.%20Satisfaction%20and%20Pt.%20Experiences.pdf

  • Pink, G. H., Holmes, G. M., D’Alpe, C., Strunk, L. A., McGee, P., & Slifkin, R. T. (2006). Financial indicators for critical access hospitals. The Journal of Rural Health, 22(3), 229–236.

    Article  Google Scholar 

  • Raghupathi, V., & Raghupati, W. (2015). Benchmarking hospital performance using health analytics. Journal of Health & Medical Informatics, 6(2), 1–13.

    Article  Google Scholar 

  • Renzi, C., Sorge, C., Fusco, D., Agabiti, N., Davoli, M., & Perucci, C. A. (2012). Reporting of quality indicators and improvement in hospital performance: The P.Re.Val.E. Regional Outcome Evaluation Program. Health Services Research, 47(5), 1880–1901.

    Article  Google Scholar 

  • Rudawska, I. (2015). Empirical verification of the scale measuring patient service quality in integrated health care in Poland. In: Entrepreneurship, Business and Economics: Vol. 2. Proceedings of the 15th Eurasia Business and Economics Society Conference, January 8–10, 2015, ISCTE-IUL Instituto Universitário de Lisboa, Lisbon, Portugal, pp. 373–383.

    Google Scholar 

  • Schmaltz, S. P., Williams, S. C., Chassin, M. R., Loeb, J. M., & Wachter, R. M. (2011). Hospital performance trends on national quality measures and the association with joint commission accreditation. Journal of Hospital Medicine, 6(8), 454–461.

    Article  Google Scholar 

  • Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. The Milbank Quarterly, 76(4), 593–624.

    Article  Google Scholar 

  • Smith, P. C., Mossialos, E., & Papanicolas, I. (2005). Performance measurement for health system improvement: Experiences, challenges and prospects. WHO. Retrieved August 13, 2015, from http://www.euro.who.int/__data/assets/pdf_file/0007/135970/E94887_Part_I.pdf

  • Stamatadias, F. G. (2009). Governmental accounting reform in the Greek public hospitals: some preliminary results of its implementation. In: 4th Hellenic Observatory PhD Symposium, 25–26 June 2009, London School of Economics and Political Science, London, UK.

    Google Scholar 

  • Tsai, T. C., Jha, A. K., Gawande, A. A., Huckman, R. S., Bloom, N., & Sadun, R. (2015). Hospital board and management practices are strongly related to hospital performance on clinical quality metrics. Health Affairs (Millwood), 34(8), 1304–1311.

    Article  Google Scholar 

  • Vašiček, D. (2008). Razvoj računovodstvenog informacijskog sustava javnog zdravstva u Republici Hrvatskoj [The development of the Croatian Public Health Sector’s Accounting Information System]. In: 1st International conference “Vallis Aurea” focus on: regional development, 19th September 2008, Polytechnic of Pozega & DAAAM International Vienna, Pozega, Croatia, pp. 987–991.

    Google Scholar 

  • Vulić, J. (2008). Interno financijsko izvještavanje u funkciji upravljanja bolnicom [Internal financial reporting in management of hospital]. In: 1st International conference “Vallis Aurea” focus on: regional development, 19th September 2008, Polytechnic of Pozega & DAAAM International Vienna, Pozega, Croatia, pp. 1017–1021.

    Google Scholar 

  • Webster, C., & Hoque, Z. (2001). Use and users of cost accounting data in a government hospital: New public management, institutionalism, power and conflicts. APIRA Conference, 15–17 July 2001, Adelaide, Australia.

    Google Scholar 

  • World Health Organization (WHO). (2003). Measuring hospital performance to improve the quality of care in Europe: a need for clarifying the concepts and defining the main dimensions. Report on a WHO Workshop Barcelona, Spain, 10–11 January 2003.

    Google Scholar 

  • World Health Organization (WHO). (2015). Croatia: Statistics. Retrieved August 06, 2015, from http://www.who.int/countries/hrv/en/

Download references

Acknowledgements

This work has been fully supported by Croatian Science Foundation’s funding of the project 8509 Accounting and financial reporting reform as a means for strengthening the development of efficient public sector financial management in Croatia. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of Croatian Science Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Verica Budimir .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this paper

Cite this paper

Budimir, V., Lutilsky, I.D., Dragija, M. (2017). Performance Measurement as the Basis for Hospitals Strategic Management. In: Bilgin, M., Danis, H., Demir, E., Can, U. (eds) Country Experiences in Economic Development, Management and Entrepreneurship. Eurasian Studies in Business and Economics, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-319-46319-3_53

Download citation

Publish with us

Policies and ethics