Reconceptualising hospital performance management as a socio-organisational system: a scoping review
Olga Schibli, Norbert Seyff, Doris Brandenberger, Thomas Ehrlich, Yiannis KyratsisBackground
Hospital performance management is frequently framed as a technical challenge centred on indicators, dashboards and analytics. Despite growing measurement infrastructures, many hospitals struggle to translate performance data into strategic leadership, effective governance and value-based improvement, suggesting that hospital performance management is a socio-organisational process shaped by leadership practices, institutional contexts and organisational dynamics. No review has systematically mapped how these socio-organisational dimensions are conceptualised across the hospital performance management literature.
Methods
Following Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidance, we conducted a scoping review across PubMed, Web of Science, Scopus and CINAHL. From 2612 records identified, 1749 unique titles and abstracts were screened. Of these, 50 met inclusion criteria; a purposive subsample of 40 studies presenting system-level or integrative frameworks underwent in-depth conceptual analysis. Findings were inductively organised into four thematic domains: tools & data; people & change; policy & governance and value-based healthcare.
Results
Hospital performance management emerges as a multidimensional, context-dependent and socially embedded phenomenon. In the included literature, performance measurement and performance management were frequently conflated, with implicit assumptions that indicator availability would translate into improvement. Technical solutions—including balanced scorecards, dashboards and analytics platforms—produced meaningful improvements only when embedded within supportive governance arrangements, engaged leadership and learning-oriented cultures. The balanced scorecard, while widely adopted, was selectively enacted according to dominant value orientations—functioning variably as a control, efficiency, learning or innovation tool depending on organisational context. Misalignment across technical tools, workforce dynamics, governance structures and value-based ambitions contributed to symbolic compliance and fragmented initiatives. A performance management architecture map and competing values framework interpretation are proposed to explain cross-study variation.
Conclusions
Hospital performance management failures stem less from inadequate indicators than from misalignment across measurement, governance, workforce and value-creation domains. Leaders should focus on aligning socio-organisational architectures, making value trade-offs explicit and using performance information to support organisational sense-making, coordination and learning rather than treating performance management as a compliance exercise.