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Introduction
Healthcare staff are under strong pressure to contain cost owing to increasing healthcare expenditure attributed to aging population, contemporary diseases and extensive costly biomedical technology (Aletras et al., 2007). At the same time, hospital managers have been strongly forced to achieve highly efficient and effective healthcare services (Weir et al., 2009). To maintain these organizational goals, various operational to strategic management activities must be tackled. As an evidence-based approach to holistic hospital management, performance measurement is being applied in modern healthcare, using key performance indicators (PIs) (van der Geer et al., 2009) based on existing or purposefully collected data (Scobie et al., 2006). Currently, several studies and projects applied the performance measurement for various management purposes; e.g., to: identify poor performance; monitor poorly performing healthcare services; and support quality improvement (Mant, 2001; Mainz, 2003; Mainz et al., 2004; Mannion and Goddard, 2002). PIs can also be used in government and health authorities; e.g., for benchmarking or accountability for the country’s healthcare performance and health policy making (Voelker et al., 2001; Curtright et al., 2000).
With increased motivation, PIs have become a major academic and public concern in healthcare management (ten Asbroek et al., 2004; Arah et al., 2006; Veillard et al., 2005). Several performance measurement frameworks or tools – each comprising different dimensions or measures, including several PIs (Groene et al., 2008) – have been developed for monitoring, tracking, assessing and managing healthcare performance. These frameworks vary, depending on organization types and specialties or fields; e.g., general-purpose and specialty-specific PIs. For instance, the balanced scorecard (Kaplan and Norton, 1992), a frequently used framework, measures and assesses organizational performance from the following four aspects: financial performance; customer satisfaction; internal processes; learning and growth. Another well-known PI framework, Donabedian (1966), adopted three healthcare performance aspects: outcome, structure and process. As a performance measurement framework, the following five categories were most frequently proposed in healthcare management: collaboration; learning and innovation; management perspective; service provision; and outcome (Klassen et al., 2010). According to a US survey (Love et al., 2008), hospital executives regarded financial performance, patient satisfaction, medical error rates and infection control as critical PIs for operations management and quality improvement. As such, there...