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

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  • Kelman, Steven

    (Harvard U)

  • Friedman, John N.

    (U of California, Berkeley)

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.

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Bibliographic Info

Paper provided by Harvard University, John F. Kennedy School of Government in its series Working Paper Series with number rwp07-034.

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Date of creation: Aug 2007
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Handle: RePEc:ecl:harjfk:rwp07-034

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  1. Julie Berry Cullen & Randall Reback, 2006. "Tinkering Toward Accolades: School Gaming Under a Performance Accountability System," NBER Working Papers 12286, National Bureau of Economic Research, Inc.
  2. Courty, Pascal & Marschke, Gerald, 2002. "An Empirical Investigation of Gaming Responses to Explicit Performance Incentives," CEPR Discussion Papers 3164, C.E.P.R. Discussion Papers.
  3. Baker, George P, 1992. "Incentive Contracts and Performance Measurement," Journal of Political Economy, University of Chicago Press, vol. 100(3), pages 598-614, June.
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Cited by:
  1. Kelman, Steven J. & Myers, Jeff, 2009. "Successfully Executing Ambitious Strategies in Government: An Empirical Analysis," Scholarly Articles 4481609, Harvard Kennedy School of Government.
  2. Carol Propper & Matt Sutton & Carolyn Whitnall & Frank Windmeijer, 2008. "Incentives and Targets in Hospital Care: Evidence from a Natural Experiment," The Centre for Market and Public Organisation 08/205, Department of Economics, University of Bristol, UK.
  3. Matt Sutton & Ross Elder & Bruce Guthrie & Graham Watt, 2010. "Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 1-13.

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