A critical analysis of strategic performance measurement in supporting estate decisions in NHS Scotland

Formal Strategic Performance Measurement Systems (SPMS’s) are not common among international healthcare providers, and those which are adopted are found largely within centralised public healthcare and often a mandatory requirement of governments. In order to understand the role of SPMS’s applied in the management of healthcare estates, this research seeks to explore the perceptions of senior NHS stakeholders across the UK on the usefulness and value of SPMS’s, with a view to draw out how it manifests itself in other countries with other healthcare governance configurations. Firstly, ten semi-structured interviews were performed with senior stakeholders directly involved in managing estate performance across different regions within UK to explore their perspectives of the value and effectiveness of SPMS’s in promoting improvement. Findings from a UK perspective informed the development of themes to explore in a series of twelve interviews with members of the EuHPN that represent eight countries to elicit the applicability of the SPMS’s within their countries. The findings revealed that SPMS's in the NHS UK are designed to support priorities and goals connected to realising the policy vision and agenda of central government, and concern was expressed that this often did not reflect the best priorities for managing the estate. The SPMS's are mainly used by governments in centralised systems as a tool for exerting power from a distance, an understanding which aligns with Foucault's understanding of governmentality and can be related to the increased need to gain a greater knowledge about how effectively money is being spent by management in order to achieve policy agendas and visions. Despite this in countries where healthcare is not as centralised as in the UK, it was found that there is an interest for adopting a similar system mainly to have a more consistent approach among the different healthcare bodies and nationally.