Conclusions
In this paper, we developed a theoretical framework of performance measurement, aiming at its application to holistic hospital management in the Japanese context. This framework emphasized applicability to evidence-based assessment from healthcare stakeholders’ perspectives ,and interpretation of assessment results to improvement actions. For the former point of view, we selected patient, employee, and management as important, key stakeholders in healthcare. Performance indicators were arranged from assessment properties as well as stakeholder perspectives. Connecting to the latter issue, the theoretical framework included two types of assessment properties:(1) healthcare outcomes – by which operational problems, faults or weaknesses in the entire organization or its departments can be identified – and (2) performance shaping factors – through which hospital managers can easily address latent causes of each problem from aspects of process, structure and culture/climate within the organization. From the literature review, it is suggested that measures from the employee perspective and related to performance shaping factors should be more frequently applied to hospital management. In addition, more indicators should be included in each measure from the patient and the employee perspectives in developing a set of “key” performance indicators, and for improving content validity, indicators on “non-frequently used” measures from the management perspective should also be added in the indicator set. From the questionnaire survey to healthcare experts, indicators on patient satisfaction, patient safety, employee satisfaction and occupational safety measures are critically important for hospital management whether in Japan or Western countries. On the contrary, a Japanese-specific trend was identified from the results of expert ratings: some indicators related to workload, i.e., over-time, length of service and the number of staff per bed, are “useful” for Japanese hospital management, while the indicators of waiting/delay, cancelation, and employee competence are “meaningless” for hospital management in the Japanese healthcare context.