Performance management in complex adaptive systems
A conceptual framework for health systems
Bibliographic Data
| ID | 21879799 |
|---|---|
| Authors | Tom Newton-Lewis (0000-0002-8488-5226, Freelance Health Systems Consultant, Oxford, UK, corresponding author), Wolfgang Munar (0000-0002-9234-987X, Milken Institute), Tata Chanturidze (0000-0003-1675-5849, Oxford Policy Management) |
| Year | 2021 |
| Volume | 6 |
| Issue | 7 |
| Pages | e005582 |
| Publication date | 2021-07-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | BMJ Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2059-7908 • E-ISSN: 2059-7908 |
| Publisher | BMJ (PUBLISHER • GB) |
| DOI | 10.1136/bmjgh-2021-005582 |
| PMID | 34326069 |
| OpenAlex | W3187045894 |
| Language | EN |
| Citations received | 5 |
| References cited | 50 |
Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making. The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context
Blueprint · Business · Conceptual framework · Economics · Incentive · Interdependence · Knowledge management · Management control system · Management science · Performance Management · Process management · Sociology · Computer Science · Engineering · Global Maternal and Child Health · Health Policy Implementation Science · Primary Care and Health Outcomes · Marketing
Shifting oversight
Characterizing the implementation of performance management interventions in a primary health care system
Complex system management
Health systems performance or performing health systems? Anthropological engagement with health systems research
How performance targets can ingrain a culture of 'performing out
Writing Integrative Literature Reviews
Public Sector Management Reform in Developing Countries
The challenge of complexity in health care
Complexity, leadership, and management in healthcare organisations
Building the Field of Health Policy and Systems Research
Organizing and the Process of Sensemaking
Literature review as a research methodology
Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries
Governing by numbers
Perceptions and experiences of frontline health managers and providers on accountability in a South African health district
Bottom-up innovation for health management capacity development
Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines
The logics of performance management
From bouncing back, to nurturing emergence
The crowded space of local accountability for maternal, newborn and child health
Decision space for health workforce management in decentralized settings
Strengthening health system leadership for better governance
Sub-national health care financing reforms in Indonesia
What’s Measured Is What Matters
How complexity science can inform scale-up and spread in health care
Complexity in health and health care systems
How does performance-based financing affect health workers' intrinsic motivation? A Self-Determination Theory-based mixed-methods study in Malawi
How performance targets can ingrain a culture of 'performing out
Hospitals as complex adaptive systems
| Unique citing works | 5 |
|---|---|
| Citations per year | 1,25 |
| Citation span | 2022 - 2025 (4) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 5 |