Performance Management and Public Sector Reform: The Norwegian Hospital Reform

Abstract

ABSTRACT This article addresses the development of new performance management systems related to public sector reforms. One such system is Management by Objectives and Results (MBOR), based on an official OECD model. Such a system tries to establish unambiguous goals, objectivity, and incentive elements into often traditionally trust-based systems embedded in a complex political-administrative context. To analyze such performance management systems and how they work in practice, we focus on a recent reform of the hospital structure in Norway. Using a broad institutional perspective, we argue that the MBOR-system in Norway is a mixed and complex system encompassing different kinds of logic. These include instrumental elements from the new performance management systems combined with ad hoc preventive efforts by the political leadership, the influence of cultural constraints, elements of rather inappropriate self-interested action, and pressure from the environment. The study reveals that the hospital reform in Norway in practice can be seen as an integrated model, combining informal trust-based approaches and formal performance management measures. It also shows that negative side effects and dysfunctions might occur.