دانلود رایگان مقاله انگلیسی اندازه گیری عملکرد برای مدیریت استراتژیک مراقبت های بهداشتی - امرالد 2018

Introduction

The healthcare estate directly contributes to the delivery of high quality healthcare for patients and it is a key enabler to change in the health system with its contribution largely undervalued and untapped (Naylor, 2017). Unfortunately, for senior management in public healthcare organisations the often vast and valuable facility portfolio presents significant challenges for decisions surrounding the long term planning of future options for the estate (i.e. new-build, modernisation, refurbishment or disposal). These decisions need to relate to the changing demand for care, driven by the aging population, epidemiology issues (change in disease pattern) and the potential impact of new technologies that have been taking place over the last forty years and that will continue with increasing impact in the coming decades. Today hospitals are structures whose design and configuration reflects the practice of healthcare and patient requirements often from a bygone era (McKee and Healy, 2000). Therefore, they are neither efficient nor functional when it comes to efficiently addressing the demands of the service now and in the future. At the same time there is an increasingly austere financial climate in many developed countries that results in cuts to public expenditure which in turn has affected budgets within the healthcare sector (Nunes et al., 2015, Stuckler et al., 2011). An increasing need has arisen to adapt the estate to reflect both current and future demands in order to avoid affecting adversely the quality of health offered to patients and its economic viability (Naylor, 2017).

Conclusions

The importance of performance measurement in estates management has been recognised by many scholars and practitioners. With a focus on healthcare, this study explored the role of performance measurement for the management of healthcare estates at the strategic level. The findings explain in part the observation that performance measurement tools are mostly adopted by governments where the healthcare property competencies are centralised. Although these findings were tied to an international review, this was limited to English speaking organisations due to a lack of engagement with a pan-EU questionnaire due to an apparent language barrier and an important realisation that in decentralised healthcare systems across the EU there was limited application of strategic performance measurement reflective of the estate. The study revealed that in NHS Scotland this system is not used in the majority of the cases for purposes other than for government accountability and in part to support government investment prioritisation. Their use as a tool for informing decisions at the strategic level is limited mainly by the finite value placed on the estate as a strategic resource within some of the NHS boards. This is resulting in data gaps, apathy and an inability from the Scottish Government to influence change within the estate. The main contribution of this study is that it provides three recommendations which can help to bridge this gap for those healthcare organisations whose governments mandate having performance measurement systems in place and for those that are planning similar implementation. These recommendations may be also extended to other sectors. However, as the study was limited to NHS Scotland, more research is required to consider the applicability of the findings in other centralised healthcare systems and importantly decentralised organisations with less demand for informing high level policy focused on strategic objectives. Given this, the next question to ask is whether the role of performance measurement can be enhanced, but also to what extent can it be extended to other organisations where the hospital governance is decentralised.