Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada.
ESCP Business School, Paris, France.
J Health Organ Manag. 2021 Mar 19;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-08-2020-0352.
Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system.
DESIGN/METHODOLOGY/APPROACH: This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors ( = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy.
Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy.
Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context.
ORIGINALITY/VALUE: This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.
国际上，许多公共医疗组织正在实施精益理念方法和绩效管理系统。然而，关于这些管理工具的益处，文献尚无定论，并且对于这些工具的大规模实施过程也知之甚少。本文旨在描述实施过程，并深入了解该过程如何影响强制性绩效管理系统。
设计/方法/途径：本研究基于对加拿大三个医疗组织的比较案例研究。数据包括文件、非参与式观察和与主要参与者（=30）的半结构化访谈。分析基于管理工具的社会技术方法，该方法考虑了组织背景、工具的技术基础、作用理论和管理理念。
结果表明，尽管有标准化的国家要求，但是在技术基础和管理理念方面，所实施的工具在不同组织之间存在差异。这些差异可以通过技术基础的灵活性、管理理念的不明确性和一些环境因素来解释。该工具在这些不同维度上的高度混合可能是成功实施的关键。精确且规定的技术基础不足以保证管理理念的实施。
如果强制性实施管理工具时明确管理理念、技术基础以及两者之间的联系，并为适应组织环境提供一定的回旋余地，那么管理工具的强制实施可能会更加成功。
原创性/价值：这是少数描述和分析公共医疗组织中强制性大规模实施绩效管理系统所涉及过程的研究之一。
