Value-based integrated performance management tools in healthcare: A sociomaterial work story

Abstract

Purpose: Explore the appropriation of control rooms (value-based integrated performance management tools) implemented in Quebec’s (Canada) publicly funded health system as a form of legitimate sociomaterial work. Design/methodology/approach: Multi-site organizational ethnographic case studies (N=2) in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 hours), individual semi-structured interviews (N=34), and document review (N=143). Findings: Three types of legitimate sociomaterial work emerge from appropriating control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional and organization work-paths: tools consistently engage in disruptive and technology work; institutions consistently engage in maintaining and strategy work, and people consistently engage in creation and boundary work. We present a refined multi-faceted theoretical framework of appropriating tools in health care as sociomaterial work, working on three intersected levels: actors, units and work. Practical implications: This paper offers a new understanding of performance management practice in health care as dynamic, inclusive and value-based (people-centred). It also offers actionable knowledge on how to create better health and organizational value with tools. Finally, it provides a new comprehensive multi-faceted theoretical framework to inform the work of appropriating tools in health care. Originality: We hope to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging both theoretical and ontological conceptions of work in healthcare organizations and beyond. Keywords: Appropriating, management tools, performance management, value-based care, integrated care, sociomaterial work, social-symbolic work, institutionalism, organizational qualitative research, multi-sites ethnographic case study, multi-level narrative process analysis