Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators

In healthcare, performance indicators are increasingly used to measure and control quality and efficiency of care-providing teams. This article demonstrates that when controllability is emphasized during indicator development, the level of task uncertainty influences the type of resulting performance indicators. We report findings from a field study in a medical rehabilitation centre in The Netherlands, where four low task uncertain teams ('hand trauma', 'heart failure', 'amputation', 'chronic pain'), and four high task uncertain teams ('children with developmental coordination disorders (DCD)', 'parkinson's disease', 'young children (0-4 years) with developmental disorders', and 'acquired brain injuries') participated in the development of performance indicators using the Productivity Measurement and Enhancement System (ProMES) method. Results show that teams higher on task uncertainty developed relatively more process indicators compared to outcome indicators, whereas the reverse was true for teams lower on task uncertainty. Additionally, process indicators developed by high task uncertain teams were more of a problem solving nature than process indicators developed by low task uncertain teams, which had a more procedural character. The study expands existing knowledge by providing a framework which explicates the task processes to be executed under different levels of task uncertainty, and in line with that appropriate performance indicators for healthcare teams.