Framing Performance Management of Acute-Care Hospitals by Interlacing NPM and Institutional Perspectives: A New Theoretical Framework

This paper develops a theoretical framework which combines ideas underlying new public management (NPM) with new institutional sociology (NIS) to explore the development of performance management during a period of healthcare reform. The framework distinguishes three categories of explanatory variables; NPM antecedents, the institutional environment and institutional elements within a three tier level of analysis; economic/political, organisational field and organisational unit level. Evidence to support the relevance and appropriateness of this framework is gathered within the Irish health service using in-depth interviews, a questionnaire and documentary data. The application of the framework highlights that all antecedents of NPM can be influential and that all institutional elements can play a role at the three different levels of analysis.