Performance Improvement and Performance Dysfunction: An Empirical Examination of Distortionary Impacts of the Emergency Room Wait-Time Target in the English National Health Service

Posted: 9 Oct 2009  

Steven Kelman

Harvard University - Harvard Kennedy School (HKS)

John N. Friedman

Harvard University - Harvard Kennedy School (HKS); National Bureau of Economic Research (NBER)

Date Written: October 2009

Abstract

The literature on the use of performance measurement in government has focused much attention on hypothesized unintended dysfunctional consequences that such measurement may produce. We conceptualize these dysfunctional consequences as involving either effort substitution (reducing effort on nonmeasured performance dimensions) or gaming (making performance on the measured performance dimension appear better, when in fact it is not). In this paper, we examine both performance impacts and dysfunctional consequences of the establishment in the English National Health Service of a performance target that no patient presenting in a hospital accident and emergency department (emergency room) wait more than 4 hours for treatment. Using data from all 155 hospital trusts in England, we find dramatic wait-time performance improvements between 2003 and 2006 and no evidence for any of the dysfunctional effects that have been hypothesized in connection with this target. We conclude by discussing when one would expect dysfunctional effects to appear and when not.

Suggested Citation

Kelman, Steven and Friedman, John N., Performance Improvement and Performance Dysfunction: An Empirical Examination of Distortionary Impacts of the Emergency Room Wait-Time Target in the English National Health Service (October 2009). Journal of Public Administration Research and Theory, Vol. 19, Issue 4, pp. 917-946, 2009. Available at SSRN: https://ssrn.com/abstract=1484515 or http://dx.doi.org/10.1093/jopart/mun028

Steven Kelman (Contact Author)

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States
617-496-6302 (Phone)
617-496-5747 (Fax)

John Norton Friedman

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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