Emergency department performance assessment using administrative data: A managerial framework

Administrative data play an important role in performance monitoring of healthcare providers. Nonetheless, little attention has been given so far to the emergency department (ED) evaluation. In addition, most of existing research focuses on a single core ED function, such as treatment or triage, thus providing a limited picture of performance. The goal of this study is to harness the value of routinely produced records proposing a framework for multidimensional performance evaluation of EDs able to support internal decision stakeholders in managing operations. Starting with the overview of administrative data, and the definition of the desired framework's characteristics from the perspective of decision stakeholders, a review of the academic literature on ED performance measures and indicators is conducted. A performance measurement framework is designed using 224 ED performance metrics (measures and indicators) satisfying established selection criteria. Real-world feedback on the framework is obtained through expert interviews. Metrics in the proposed ED performance measurement framework are arranged along three dimensions: performance (quality of care, time-efficiency, throughput), analysis unit (physician, disease etc.), and time-period (quarter, year, etc.). The framework has been judged as "clear and intuitive", "useful for planning", able to "reveal inefficiencies in care process" and "transform existing data into decision support information" by the key ED decision stakeholders of a teaching hospital. Administrative data can be a new cornerstone for health care operation management. A framework of ED-specific indicators based on administrative data enables multi-dimensional performance assessment in a timely and cost-effective manner, an essential requirement for nowadays resource-constrained hospitals. Moreover, such a framework can support different stakeholders' decision making as it allows the creation of a customized metrics sets for performance analysis with the desired granularity.

Translating knowledge management into performance

Purpose

This paper aims to tie together insights from the body of research on knowledge management (KM) and management accounting control systems to propose a conceptual model in which performance measurement systems (PMS) can play a role in translating knowledge resources into enhanced performance.

Design/methodology/approach

The underlying assumption of the “fit-as-mediation” approach signifies that knowledge features can play a role in the determination of the structure and implementation of particular managerial processes and this, in turn, may support information processing and lead to desirable results within organizations.

Findings

Synthesizing theory from performance measurement and the knowledge-based view of the firm, the paper’s analysis and discussions elucidate how the implementation of an overarching PMS, i.e. diversity of measurement, could translate the knowledge-related factors, i.e. knowledge resources and knowledge process capabilities, into enhanced performance. In particular, the proposed model shows that a comprehensive PMS plays an intervening role between KM and organizational performance.

Research limitations/implications

The proposed model may inspire a new research agenda to show how knowledge initiatives are managed and measured in organizations and how they are properly aligned with specific managerial processes to deliver real value.

Practical implications

Drawing upon the conceptualized associations among KM, PMS and organizational performance, this paper recommends some practical guidelines by highlighting the importance of PMS whereby organizations may reap maximum benefit from their KM initiatives.

Originality/value

This paper sheds new light on the links between KM and organizational performance, and it appears to be the first study to propose an intervening effect of PMS between KM and organizational performance.

Measuring strategic performance in construction companies: a proposed integrated model

Purpose

– This paper aims to examine and compare a performance measurement system and performance frameworks commonly used within the construction industry. The paper explores the strengths and weaknesses of balanced scorecard (BSC) and business excellence model (BEM) to propose an integrated model for measuring strategic performance of construction organisations as a single model. The purpose is to help organisations achieve performance excellence, financial integrity and continuous improvement in business results to sustain competitive advantage.

Design/methodology/approach

– This paper examines and compares performance measurement system and performance frameworks commonly used within the construction industry. The paper explores the strengths and weaknesses of BSC and BEM to propose an integrated model for measuring strategic performance of construction organisations as a single model. The purpose is to help organisations achieve performance excellence, financial integrity and continuous improvement in business results to sustain competitive advantage.

Findings

– The study reveals that the most popular performance measurement framework in construction includes: BSC; Key Performance Indicators and European Foundation for Quality Management. However, literature also reveals that Malcolm Baldrige National Quality Award is being used to measure performance in the construction. The study findings indicated that BSC and BEM could be combined to provide an integrated model that will encompass every facet of construction performance measures.

Research limitations/implications

– The paper integrates the BSC and BEM performance measurement models, to provide construction organisations the opportunities of benefitting from the two models as a single tool without having to use more than one model or miss out any important aspect of performance measures. The model will assist organisations perform regular health checks of all business process and at the same time help align organisational activities with strategic primacy.

Practical implications

– The paper offers an integrated construction excellence model as a useful tool for measuring both financial and non-financial performance aspects of construction organisations. This will provide managers, owners and other stakeholders the chance of measuring processes and pre-eminent strategic initiatives using a single model.

Originality/value

– The conceptual paper presents an integration of processes and perspectives for measuring performance as a new and useful tool in the context of the South African construction industry. The paper suggests that research efforts should be directed on how to implement the strategic performance model efficiently within a specific construction environment.