Reconceptualising hospital performance management as a socio-organisational system: a scoping review

Abstract

BACKGROUND: Hospital performance management is frequently framed as a technical challenge centred on indicators, dashboards and analytics. Despite growing measurement infrastructures, many hospitals struggle to translate performance data into strategic leadership, effective governance and value-based improvement, suggesting that hospital performance management is a socio-organisational process shaped by leadership practices, institutional contexts and organisational dynamics. No review has systematically mapped how these socio-organisational dimensions are conceptualised across the hospital performance management literature. METHODS: Following Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidance, we conducted a scoping review across PubMed, Web of Science, Scopus and CINAHL. From 2612 records identified, 1749 unique titles and abstracts were screened. Of these, 50 met inclusion criteria; a purposive subsample of 40 studies presenting system-level or integrative frameworks underwent in-depth conceptual analysis. Findings were inductively organised into four thematic domains: tools & data; people & change; policy & governance and value-based healthcare. RESULTS: Hospital performance management emerges as a multidimensional, context-dependent and socially embedded phenomenon. In the included literature, performance measurement and performance management were frequently conflated, with implicit assumptions that indicator availability would translate into improvement. Technical solutions-including balanced scorecards, dashboards and analytics platforms-produced meaningful improvements only when embedded within supportive governance arrangements, engaged leadership and learning-oriented cultures. The balanced scorecard, while widely adopted, was selectively enacted according to dominant value orientations-functioning variably as a control, efficiency, learning or innovation tool depending on organisational context. Misalignment across technical tools, workforce dynamics, governance structures and value-based ambitions contributed to symbolic compliance and fragmented initiatives. A performance management architecture map and competing values framework interpretation are proposed to explain cross-study variation. CONCLUSIONS: Hospital performance management failures stem less from inadequate indicators than from misalignment across measurement, governance, workforce and value-creation domains. Leaders should focus on aligning socio-organisational architectures, making value trade-offs explicit and using performance information to support organisational sense-making, coordination and learning rather than treating performance management as a compliance exercise.