UK health sector performance management: Conflict, crisis and unintended consequences

This paper investigates the consequences of particular approaches to the design of performance management systems, for organisations in the UK health sector. A case study approach is adopted to investigate the impact of a new performance management system imposed from a distance by regulatory bodies on English hospital Trusts. The theoretical framework integrates structuration and institutional theories in order to understand how practices are institutionalised or changed at three levels, emphasising the crucial role of agency in structuring organisational and institutional practices. It reveals the potential for conflict, crisis and unintended consequences in organisations where instrumental approaches are adopted.

► We examine consequences of performance management system design for 2 UK hospitals.
► Dangers of instrumental approach to design are discussed.
► Theoretical framework highlights how practices may be institutionalised or changed.
► Potential for conflict, crisis and unintended consequences is revealed.