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This paper aims to improve our understanding of performance measurement systems in the health and care sector, by focussing on employee reactions to core performance measurement practices. Targets and monitoring are hypothesised to be associated with employee perceptions of job control, supportive management and job demands, which in turn, are expected to be linked to employee-wellbeing and organisational commitment.

Matched employee workplace data are extracted from a nationally representative and publicly available survey. Structural equation models are estimated.

Performance measurement systems are neither perceived as resources nor additional demands. Setting many targets and a focus on productivity can lead to negative employee outcomes, since these positively correlate with perceptions of job demands, which negatively correlate with employee wellbeing. However, monitoring financial performance and monitoring employee performance may be helpful to managers, as these are positively associated with employee perceptions of job control and supportive management, which positively correlate with job satisfaction and organisational commitment and, negatively, with anxiety. Overall, common criticisms of performance measurement systems in healthcare are questioned.

Given the lack of consensus on how performance measurement systems can influence employee experiences and outcomes, this study combines theories that argue for performance measurement systems in managing operations with models developed by psychologists to describe how perceptions of the work conditions can affect employee attitude and wellbeing. A conceptual model is therefore developed and tested, and potential direct and indirect effects of performance measurement systems in the health sector are inferred.

As a Quality Management (QM) framework, the European Foundation for Quality Management (EFQM) Excellence Model has stakeholder management at its core. In EFQM (2012), based on which assessments were made until 2021, “creating a sustainable future” was a fundamental principle, but how it translated to a Sustainability Orientation and delivered to stakeholders remains questionable. This study aims to investigates the Sustainability Orientation within EFQM (2012) and its associations with Results for stakeholders.

Longitudinal assessments of recognized-for-excellence organizations by a partner of EFQM are considered. Using factor analysis, scores on the sub-criteria that defined “creating a sustainable future” are investigated, and a Sustainability Orientation is inferred. Panel regressions and structural equation modeling assess the correlations between Sustainability Orientation and Results. A qualitative analysis follows, where sustainability reports from role-models within this population are text mined to examine whether and how they reflected the guidance in EFQM (2012) concerning “creating a sustainable future”.

Direct and indirect positive associations between the Sustainability Orientation implied by EFQM (2012) and stakeholder-performance are confirmed. Yet, inferences from text mining of reported priorities of role-models of excellence illustrate that EFQM (2012) might have driven different strategies towards sustainability.

Despite conceptualizations that the EFQM model embeds a Sustainability Orientation, to the best of the researchers’ knowledge, its existence and likely impact remain to be examined. By combining longitudinal statistical analysis, structural equation models and text mining, consistent insights on the link between Sustainability Orientation and organizational performance are obtained.