Performance management in primary healthcare services: evidence from a field study

Paulino Silva (ISCAP – IPP, S. Mameda de infesta, Portugal)
Aldónio Ferreira (Department of Accounting and Finance, Monash University, Clayton, Australia)

Qualitative Research in Accounting & Management

ISSN: 1176-6093

Publication date: 23 November 2010



There is a growing interest in research focusing on performance management practices in the public sector, but research is still limited with regards to public primary healthcare services (PHSs), which play an important role in national healthcare systems. These organisations are frequently criticised for alleged poor performance management practices and misuse of resources, though such claims are not always substantiated. The purpose of this study is to examine performance management practices in public PHSs.


Three case studies of PHSs organisations were conducted resulting in interview material and archival data. Otley's performance management framework was used to examine the data.


It is found that the performance management systems of the studied PHSs were disjoint and lacked consistency and coherence. Lack of direction and motivational were key issues in PHSs. Furthermore, the observations indicate that vertical controls between PHSs and parent organisation were weak and accountability poor.

Research limitations/implications

Generalisability of findings and social desirability bias are the important limitations. A key research implication is that the conceptual framework adopted can be meaningfully used to generate insights into performance management issues in public sector healthcare organisations.

Practical implications

The study highlights the implications of the poor design and use of performance management systems and highlights areas for improvement in the organisations studied, and potentially across the sector.


This study is the first to draw upon Otley's performance management framework to examine performance management practices in PHSs and to demonstrate its usefulness in this context.



Silva, P. and Ferreira, A. (2010), "Performance management in primary healthcare services: evidence from a field study", Qualitative Research in Accounting & Management, Vol. 7 No. 4, pp. 424-449.

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