Tøssebro Jan, Mjøen Odd Morten, Bruteig Rebekka
NTNU Social Research, Trondheim, Norway.
Department of Social Work, Norwegian University of Science and Technology, Trondheim, Norway.
Front Rehabil Sci. 2022 May 11;3:878338. doi: 10.3389/fresc.2022.878338. eCollection 2022.
Performance measurement is growing in importance as a management tool in services for disabled people.
The aim of this article is to add to the existing literature by exploring (a) the motivation for the introduction of such measurements, (b) the reasoning behind the choice of current indicators, and (c) the impact of performance measurements on service delivery.
(1) A study of documents (national and, if available, also local) on the motivation for, choice of, and implementation of quality measurements, and (2) interviews with top and middle managers in community services for people with intellectual disabilities or mental health difficulties.
A varied set of motivations have been identified, including the intention to introduce a more facts-based and transparent governance, the need for information that supports the management of scarce resources, and as a tool in the development of service quality for users. The motivation appears to be dependent on level of government, and the attitude among service unit managers tends to be ambivalent; they want performance measurements but cannot see how to measure the important aspects of service quality. The choice of actual indicators is subject to a process bias; that is, one measures what is easily available in administrative systems. The results concerning impact on services are less clear and also context dependent. We have identified usage in the search for cost-cutting possibilities, defense against critique, and that reporting runs the risk of reinforcing routinization of services.
The possible impact on services is discussed. Layers of ambiguity are outlined, as measurements can be tools both for quality development and in the defense of current services against "unrealistic demands" from the media or stakeholders. The measurements tend to be used more as sources of governance information than tools for quality development.
The impact of quality measurement is rather ambiguous. On the one hand, it functions as a tool for budget control, whereas on the other hand, unit managers call for better measurement of user outcomes and expect that such measurement can balance the current preoccupation with input indicators, such as expenditures.
绩效评估作为一种管理工具，在残疾人服务领域正变得越来越重要。
本文旨在通过探讨以下内容来丰富现有文献：（a）引入此类评估的动机；（b）当前指标选择背后的理由；（c）绩效评估对服务提供的影响。
（1）研究关于质量评估的动机、选择和实施的文件（国家层面的，如有可能还包括地方层面的）；（2）采访为智障或有心理健康问题的人群提供社区服务的高层和中层管理人员。
已确定了一系列不同的动机，包括引入更基于事实和透明治理的意图、对支持稀缺资源管理的信息的需求，以及作为用户服务质量发展的工具。动机似乎取决于政府层级，服务单位经理的态度往往模棱两可；他们希望进行绩效评估，但不清楚如何衡量服务质量的重要方面。实际指标的选择存在过程偏差；也就是说，人们衡量的是行政系统中容易获取的内容。关于对服务影响的结果不太明确，且也取决于具体情况。我们发现绩效评估可用于寻找削减成本的可能性、抵御批评，以及报告存在强化服务常规化的风险。
讨论了对服务可能产生的影响。概述了多层模糊性，因为评估既可以是质量发展的工具，也可以用于保护当前服务免受媒体或利益相关者的“不切实际要求”。评估往往更多地被用作治理信息的来源，而非质量发展的工具。
质量评估的影响相当模糊。一方面，它作为预算控制的工具发挥作用；另一方面，单位经理呼吁更好地衡量用户成果，并期望这种衡量能够平衡当前对诸如支出等投入指标的关注。
