How performance targets can ingrain a culture of 'performing out
An ethnography of two Indian primary healthcare facilities
Bibliographic Data
| ID | 4595393 |
|---|---|
| Authors | Priya Das (0000-0002-3449-7516, corresponding author), Tom Newton-Lewis (0000-0002-8488-5226), Karima Khalil (0000-0001-5600-4682), Madhavi Rajadhyaksha, Phalasha Nagpal (0000-0001-8467-7788) |
| Year | 2022 |
| Volume | 300 |
| Pages | 114489 |
| Publication date | 2022-05-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2021.114489 |
| PMID | 34702616 |
| OpenAlex | W3205658968 |
| Language | EN |
| Citations received | 8 |
| References cited | 35 |
Low- and middle-income country health systems often apply decontextualised and unrealistic performance targets to facilities. This can lead to empty compliance and 'performing out', whereby managers and providers manipulate or inflate data to create the false impression of a functional system. While this is a well-recognised pitfall of audit-style performance accountability processes, the social processes by which these practices emerge has not been well described in the literature. In this paper, with a focus on maternal and newborn care, we seek to better understand how and why the practices of 'performing out' occur, and their implications for health system functioning, organisational culture, and quality of care. We do this through a focused facility ethnography undertaken in two primary healthcare facilities in an eastern Indian state, anonymised as Esma, where practices of 'performing out' are prevalent. We draw on the understanding that health systems are complex adaptive systems encompassing both hardware and software elements, where individual behavioural practices are an outcome of the system as a whole. To unpack how the dynamic interactions between system elements and agents influence individual behaviours, we draw upon the sociological theories of practice of Bourdieu, encompassing the concepts of field, habitus, and capital. This lens helps illustrate how resource scarcity, unyielding application of unrealistic targets with punitive sanctions for non-achievement, and complex power dynamics lead system actors to manipulate data and create documentation to show the achievement of targets that were not actually met. The practices of 'performing out' are shaped by, and in turn shape, the organisational culture of the facilities, with perverse behaviour becoming part of an entrenched habitus - the 'dispositions' of agents that guide behaviour and thinking. In the longer term, the habituation of 'performing out' contributes to a systemic orientation toward sub-par performance, undermining quality of care
Accountability · Audit · Business · Economic growth · Economics · Ethnography · Habitus · Health care · Knowledge management · Political science · Public relations · Scarcity · Sociology · Computer Science · Global Maternal and Child Health · Islamic Finance and Banking Studies
Health systems performance or performing health systems? Anthropological engagement with health systems research
Performance management in complex adaptive systems
Data for whom? Experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania
“Implementing a policy is something else”. Governance of a complex health management information system and its digitalization in Tanzania
How has the concept of health system software been used in health policy and systems research? A scoping review
Defining focused ethnography
Partial pictures
Getting the numbers right
What Are Microfoundations?
The Sociology of Habit
Building the Field of Health Policy and Systems Research
The Interpretation of Cultures
Performance management in complex adaptive systems
Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries
The Logic of Practice
Trust and teamwork matter’
Bottom-up innovation for health management capacity development
Social values and health systems in health policy and systems research
Guidance on Performing Focused Ethnographies with an Emphasis on Healthcare Research
Toward an Integration of Gender into Bourdieu’s Concept of Cultural Capital
From bouncing back, to nurturing emergence
The crowded space of local accountability for maternal, newborn and child health
Best Resources on Power in Health Policy and Systems in Low- And Middle-Income Countries
Practice theory and education. Diffractive readings in professional practice
What’s Measured Is What Matters
Implementing community interventions for HIV prevention
Convince Your Patients and You Will Convince Society
Between orchestrated and organic
An Audit of Political Behavior Research
Institutions
Acts of Resistance
Studying actions in context
Pierre Bourdieu and transformative agency
Audit Culture Revisited
So, How Did Bourdieu Learn to Play Tennis? Habitus, Consciousness and Habituation
| Unique citing works | 8 |
|---|---|
| Citations per year | 1,6 |
| Citation span | 2021 - 2026 (6) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 7 |