2009/02/06 by S. Kelman, Steven Kelman, John N. Friedman +1 · 3 citations
Business, Management and Accounting · Economics, Econometrics and Finance · Social Sciences · #Accounting and Organizational Management #Healthcare Policy and Management #Public Policy and Administration Research
paper · pdf · doi:10.1093/jopart/mun028
openalex publication_date 2009/02/06 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
The literature on the use of performance measurement in government has focused much attention on hypothesized unintended dysfunctional consequences that such measurement may produce. We conceptualize these dysfunctional consequences as involving either effort substitution (reducing effort on nonmeasured performance dimensions) or gaming (making performance on the measured performance dimension appear better, when in fact it is not). In this paper, we examine both performance impacts and dysfunctional consequences of the establishment in the English National Health Service of a performance target that no patient presenting in a hospital accident and emergency department (emergency room) wait more than 4 hours for treatment. Using data from all 155 hospital trusts in England, we find dramatic wait-time performance improvements between 2003 and 2006 and no evidence for any of the dysfunctional effects that have been hypothesized in connection with this target. We conclude by discussing when one would expect dysfunctional effects to appear and when not.