Benchmarking som ledelsesredskab til økonomistyring af hospitaler i Region Hovedstaden

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Benchmarking som ledelsesredskab til økonomistyring af hospitaler i Region Hovedstaden

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Title: Benchmarking som ledelsesredskab til økonomistyring af hospitaler i Region Hovedstaden
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Author: Fischer, Thea Kølsen
Abstract: This master thesis investigates the use of benchmarking as a governance tool in Danish public hospitals by presenting and analyzing a recent process in which regional authorities conducted a benchmarking of clinical services in the capital region of Copenhagen in order to compare and studies the impact of the benchmarking process on clinical managers in the targeted departments. New Public Management (NPM) inspired perspectives with a focus on control productivity and performance have dominated the Danish public healthcare sector since the early 1990es. The demand for performance is growing due the imperative to control costs and recent political announcements of major cut-downs ahead. Benchmarking is recommended by the Danish governance administrators as a tool to identify potential savings. The thesis´ methodological framework is based on data-triangulation: empiric data generated through systematic use of quality indicators to identify challenges in two benchmarking reports of comparisons of expenditures, personnel, and activities at capital region hospitals combined with data generated through interviews of eight executive consultants addressing the experienced challenges and potential impact of these. The theoretical perspective is mainly inspired by a phenomenological perspective and is based on an inductive approach when planning the collection of empirical data whereas the analysis of the benchmarking reports reflects perspectives of realism in the merely deductive approach to the reports. The main findings of the report analysis include identification of profound methodological weaknesses, in particular related to challenges of the comparability of key indicators. Some reservations for comparability are addressed in the reports but not taken into consideration in the conduct of comparisons. The identified flaws challenge the validity of the report findings. Analysis of interview data disclose substantial frustrations and methodological as well as managerial challenges perceived by the clinical directors, as the process being unfair and their influence only symbolic. Surprisingly, the clinical directors expressed that despite frustrations experienced most still managed to remain motivated and satisfied with their work. The level of job-related motivation and satisfaction was linked to the level of support given by their leaders within the hospitals. The core-conclusions concern the fact that the worst perspectives of the benchmarking process might not be those of weak methods, questionable findings without considerations for practical consequences and a disrespectful management of the process by the economist consultants involved. The worst perspectives might well relate to the fact that the reports are indeed well written and might thus be well taken by high-up decision makers without the necessary focus on the identified major pitfalls.
URI: http://hdl.handle.net/10417/6216
Date: 2017-02-16
Pages: 55 s.
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