The use of multilevel performance indicators in managing performance in health care organizations

The performance construct may be one of the most elusive in organization theory. Health care organizations are particularly complex owing to their dual lines of accountability, i.e. professional and administrative. This article examines the factors affecting performance indicator development and use at the technical/managerial and institutional levels, including the accreditation process and the relationship between levels. Using institutional and rational/goal theory, the motivations behind performance measurement behavior at different organizational levels was explored. Results show that the institutional level is motivated by legitimacy while the technical/managerial level is motivated by rationality. Tensions exist between the two levels and between indicator development and use.