The Ambiguous Impact of Performance Measurement on Service Quality.
Jan Tøssebro, Odd Morten Mjøen, Rebekka Bruteig
PMID 36189028WHAT IT FOUND
Managers in disability services say performance indicators mostly track budgets and staff processes, not user outcomes.
This focus can drive cost-cutting and turn documentation into routine box-ticking, potentially displacing professional judgment and individualized care.
Key findings
01Local authorities prioritize indicators that are easily retrieved from administrative systems, which are predominantly input and process factors like costs and staffing rather than user outcomes.
02Benchmarking expenditure data can create pressure for cost-cutting, described by authors as resembling a 'race to the bottom' where municipalities learn from those who spend the least.
03Routinized reporting on process indicators may replace professional discretion and individual tailoring, as staff focus on completing scheduled tasks rather than reflecting on service quality.
STILL TO COME
How it was doneWhat they found
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What it does not show
No data from street-level staff or users directly; perspectives were from managers and administrators. Limited number of interviews and local authorities; findings may not be generalizable. Study context is a system still developing, so effects of mature measurement systems are unknown. Authors note that lack of observed strategic behavior may be due to underdeveloped measurement systems rather than their absence.
Declared interests
Funded by the Research Council of Norway. Authors declared no commercial or financial conflicts of interest.
The easy way to misread this
Do not conclude that performance measurement itself causes poor care. The study found that the specific choice of input and process indicators, driven by administrative convenience and fiscal pressure, shifted focus away from user outcomes. The impact depends on how indicators are selected and used in context.