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

49 Pages Posted: 19 Sep 2007

See all articles by Steven Kelman

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: August 2007

Abstract

The literature on the use of performance measurement in government has featured prominent attention to hypothesized unintended dysfunctional consequences such measurement may produce. We conceptualize these dysfunctional consequences as involving either effort substitution (reducing effort on non-measured 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 establishment in the British National Health Service of a performance target that no patient presenting in a hospital accident and emergency department (emergency room) wait more than four hours for treatment. Using data from all 155 hospitals 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.

Keywords: Public Management, Welfare / Health Care/ Social Policy, Performance Measurement, Hospital Performance, Emergency Room Response

Suggested Citation

Kelman, Steven and Friedman, John Norton, Performance Improvement and Performance Dysfunction: An Empirical Examination of Impacts of the Emergency Room Wait-Time Target in the English National Health Service (August 2007). KSG Working Paper No. RWP07-034. Available at SSRN: https://ssrn.com/abstract=976553 or http://dx.doi.org/10.2139/ssrn.976553

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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