Health Care Indicator Selection Processes and their Impact on Clinical Unit Managers’ Motivation and Self-Efficacy to Improve Performance

Abstract

Objective: It is unclear what processes health care organizations use to identify the performance indicators they use, how targets are set, who is involved, and what impact these processes have on performance. This dissertation develops a standardized indicator selection process framework, researches its applicability within real world-settings, and seeks to understand the impact those processes have on clinical unit managers’ motivation and self-efficacy to improve performance.

Methods: Three studies, including a scoping review on international indicator selection processes; a qualitative multiple-case study of four hospital indicator selection practices; and a qualitative multiple-case study on the impact indicator selection processes have on 22 front-line clinical unit managers, were undertaken.

Results: Study One developed the 5-P Indicator Selection Process Framework; a practical structure health care agencies can use to design indicator selection processes. Study Two identified deficiencies in hospital indicator selection processes and proposed the need for adopting evidence-based selection criteria, considering finance and human resources indicators in addition to clinical indicators, adopting clearer approaches to target setting, and engaging a broader set of end-users in the process. Study Three found that clinical unit managers are often not involved in indicator selection, want to learn more about measurement, and are more likely to be motivated by process indicators that measure clinical quality and patient safety compared to outcome or business-based indicators that measure financial and human resources performance.

Conclusion: This dissertation’s contributions include a new indicator selection process framework. It highlights that current processes have not sufficiently considered business-based indicators despite the economics of health care. It uncovers that front-line clinical unit managers are not involved in, and by extension, are not motivated by hospital-wide indicator selection processes. To increase clinical unit managers’ motivation and self-efficacy to improve performance, indicator selection processes should involve them as participants, consider process indicators that measure quality, patient safety and clinical practice, and provide them training, orientation, and more time to focus on performance improvement.