Stakeholder expectations of performance in public healthcare services

Purpose - The purpose of this paper is to explore stakeholder expectations of performance within public healthcare services from a less-developed economic context – Zambia in this case. The study emerges from extant literature indicating potential variations in stakeholder conceptions and expectations of performance within public services. Design/methodology/approach - The paper draws on institutional and structuration theories to investigate cross-sectional stakeholder expectations of performance together with power relations embedded within public healthcare performance expectations. Empirical data are drawn from semi-structured interviews with 33 stakeholders including legislators, policymakers, regulators of health services, healthcare professionals and health facility managers. Findings - The findings not only reiterate the constructed and multi-dimensional nature of performance but also highlight the hierarchical configuration of stakeholder expectations linking macro-level health outcomes with micro facility-level service delivery processes. Practical implications - The study points towards the need of harmonising the national performance measurement (PM) framework to ensure that macro-level goals are suitably cascaded and translated into micro-level service delivery processes through bottom-up structuration linkages. Originality/value - In addition to filling the gap of explicating public healthcare PM practices in a less-developed economic context, the paper integrates insights from institutional and structuration theories to depict stakeholder expectations of performance through a multi-level and hierarchical framework.