To read this content please select one of the options below:

Performance management in healthcare: a critical analysis

Sarah J. Hewko (Faculty of Nursing, University of Alberta, Edmonton, Canada)
Greta G. Cummings (Faculty of Nursing, University of Alberta, Edmonton, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 1 February 2016




The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals.


PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas’ theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words “performance” and “management” and of the term “performance management”.


Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced.

Practical implications

At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance.


In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.



The authors would like to thank Dr Brenda Cameron, Professor Emerita and Dr Robert Desjardins, Graduate Writing Advisor for their feedback on early drafts of this manuscript.


Hewko, S.J. and Cummings, G.G. (2016), "Performance management in healthcare: a critical analysis", Leadership in Health Services, Vol. 29 No. 1, pp. 52-68.



Emerald Group Publishing Limited

Copyright © 2016, Emerald Group Publishing Limited

Related articles