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Enhancing performance in health care: a theoretical perspective on agency and the role of information
Author(s) -
Goddard Maria,
Mannion Russell,
Smith Peter
Publication year - 2000
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/(sici)1099-1050(200003)9:2<95::aid-hec488>3.0.co;2-a
Subject(s) - dysfunctional family , health care , incentive , control (management) , context (archaeology) , principal–agent problem , management control system , agency (philosophy) , perspective (graphical) , perfect information , information system , public relations , business , knowledge management , psychology , sociology , economics , corporate governance , political science , computer science , management , mathematical economics , artificial intelligence , law , psychotherapist , economic growth , biology , microeconomics , paleontology , finance , social science
This paper examines the role of information in securing control of health care systems. The discussion focuses on the impact of the proposed ‘Performance Framework’, which entails a significant increase in the importance attached to formal performance indicators in the management of the UK National Health Service. The paper starts with a discussion of the role of performance data in securing organizational control within health care systems and summarizes recent research into the behavioural consequences of seeking to control health care agents using such information. A theoretical principal/agent model is then used to illustrate the incentives that exist for dysfunctional behaviour within health care when only imperfect information systems are available. The theoretical results are then examined in the context of a qualitative empirical study, which elicited the perceptions of managers and health care professionals connected with eight NHS hospitals. The study confirmed the existence and importance of serious dysfunctional consequences arising from the use of information as a means of control, and concludes that the Performance Framework will be successful only if it is used in careful conjunction with other means of control. Copyright © 2000 John Wiley & Sons, Ltd.