Abstract:
Aim – The aim of this thesis was to develop a performance management framework for public health purchasers working with community health services contractors. The research began by examining the appropriateness of the Deming cycle (known as Plan-Do-Check-Act or PDCA) as a platform for building the performance management framework. It subsequently found that the original structure of the PDCA mismatches the ongoing nature of the community health services purchasing process leading to a modified version called the Planning- Delivery-Improvement (PDI) cycle. Methods – As a qualitative enquiry, an action research was designed to find the elements required in the performance management framework. This action research comprised three cycles, each of which consisted of a series of steps. The data collection and analysis, which employed various tools and techniques, continued concurrently along the three cycles. The validity of the findings was secured through constantly returning to participants who would then verify the interpretations and interim results. At the end of the research, a group of experts who had not participated in any of the earlier steps validated the performance management framework. Findings – The major output of this study is the creation of a multi-stakeholder performance management framework for the community health services purchasing process. The PDCA cycle was adjusted to the characteristics of the community health services contracting process culminating in the Planning-Delivery- Improvement (PDI) cycle. Other findings included the revelation of the continuity of the CHS performance management process beyond the scope of annual purchasing, dynamic rankings of stakeholders based on the stage of the community health services purchasing process, and integrating service improvement as a stage into the community health services performance management. Contributions – The study first provides a multi-stakeholder framework for performance management of community health services contractors. Second, it extends the application of the PDCA cycle into an Inter-organisation Relationships level and adjusts the PDCA to the ongoing nature of the community health services purchasing process using a modified framework to integrate service improvement into the community health services performance management (PDI cycle). Third, it shows how process maps can be used to identify stakeholders and the dynamic nature of stakeholder rankings. The conclusion sets out a number of directions for future research and outlines how the findings reported in this thesis can be further developed.