Indonesia and the challenge of improving services in public hospitals via performance measurement

  • Wulan Sari

    Student thesis: Professional Doctorate


    To improve the quality of services in health care provided by hospitals, the government of Indonesia uses performance measurement. However, some studies show that the relationship between organizational performance measurement and the quality of care is not clear. It does not follow a set trajectory in a lock-step fashion. Nevertheless studies do show that performance measurement can produce significant improvement in the quality of services. This study focuses on qualitative analysis of the link between performance measurement, organizational learning, and quality improvement in four different public hospitals. The overall research question is “how are processes of performance measurement linked or not linked to organizational learning in public hospitals as a pathway to improve the quality of their services?” This study uses case studies of experience in performance measurement use in two C Class and two B Class public hospitals as they seek to improve the quality of health provision. These four public hospitals are located across Indonesia. Three exemplars drawn from the experiences of the four public hospitals show that measurement takes place as a separate activity within the many routines and processes in each hospital. The consequence of measurement occurring as a separate activity is that the expected single feedback loop is broken into many smaller activities. In the modified feedback loop the quality of measurement activity is shown to be pivotal and measuring activity can contribute to learning by reinforcing successful routines. At the same time poor practices in measurement can encourage routines which detract from learning. Significant implications are evident for the role of performance measurement in organizational learning, for the importance of feedback loops in measurement, and for the possibility to adapt government regulation in Indonesia to different classes of public hospitals.
    Date of Award2016
    Original languageEnglish
    SupervisorChris Sadleir (Supervisor) & Anni Dugdale (Supervisor)

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