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Linköping Studies in Science and Technology Dissertation No. 1092 Dissertation from the International Graduate School of Management and Industrial Engineering, IMIE No. 108, Doctoral Dissertation Performance Measurement Systems in Swedish Health Care Services Beata Kollberg Quality Technology and Management Department of Management and Engineering Linköpings universitet, SE-581 83 Linköping, Sweden © Beata Kollberg, 2007 ISBN: 978-91-85715-19-0 ISSN: 0345-7524 Printed by: LiU-Tryck, Linköping Distributed by: Linköpings universitet Division of Quality Technology and Management Department of Management and Engineering SE-581 83 Linköping Tel: +46 13 28 2448 Fax: +46 13 28 2742 ABSTRACT In the quality management literature, measurements are attributed great importance in improving products and processes. Systems for performance measurement assessing financial and non-financial measurements were developed in the late 1980s and early 1990s. The research on performance measurement systems has mainly been focused on the design of different performance measurement systems. Many authors are occupied with the study of the constructs of measures and developing prescriptive models of performance measurement systems. There is a need in the research to shift focus from studying the construct of measurements to how they are used in real face-to-face situations in specific contexts. The purpose of this thesis is to analyse the development, i.e. the design, implementation and use, of performance measurement systems in Swedish health care services. The study aims to increase the understanding of the role of performance measurement system in Swedish health care and thereby support health care improvements in general. Three research questions have been derived from the purpose. (1) How and why are performance measurement systems being developed in Swedish health care services? (2) What problems can be identified in the development? (3) What enabling factors can be identified in the development? A qualitative research strategy was selected for the research. The research is based on a multiple case study design conducted within two research projects and information has been gathered through interviews, documents and observations. The idea of performance measurement systems develops through several tracks when implemented in health care and the development follows a purposeful process of activities. The development was initiated when major changes occurred in the organisation or its environment. Performance measurement systems are primarily used to support a dialogue between management and employees regarding organisational improvement. Problems experienced are related to struggles to reach national consensus for measures, involving management, and the clarification of various end-users’ needs. Enabling factors are the frequent interaction with people developing the system, management’s involvement, the use of multi-skilled teams, and visual displays. The research contributes to several insights to the research area of performance measurement system and health care practitioners. The research shows that the development process is far from straight forward and is formed by the influence of factors in the organisational context, which cannot always be predicted. By seeing the development as an innovation process, the focus is broadened from being technological towards the organisation as whole, which contribute to the existing research on performance measurement systems. ACKNOWLEDGEMENTS A number of people have generously contributed (although I am solely responsible for any flaws and inconsistencies) during the process of writing this dissertation and thus a million thanks are due! My main advisor, Jens Jörn Dahlgaard, has offered great advice and valuable support throughout the research process. My co-advi