Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice
Abstract Background Performance management (PM) systems in healthcare consist of many interacting interventions, such as contracts, scorecards and incentives. The diversity, complexity and poor description of PM interventions hampers replication in research, standardized comparative analysis and acc...
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BMC
2025-02-01
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| Series: | Health Research Policy and Systems |
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| Online Access: | https://doi.org/10.1186/s12961-025-01284-1 |
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| author | Jenna M. Evans Sarah M. Wheeler |
| author_facet | Jenna M. Evans Sarah M. Wheeler |
| author_sort | Jenna M. Evans |
| collection | DOAJ |
| description | Abstract Background Performance management (PM) systems in healthcare consist of many interacting interventions, such as contracts, scorecards and incentives. The diversity, complexity and poor description of PM interventions hampers replication in research, standardized comparative analysis and accumulation of evidence. Specifying PM systems and interventions in terms of their behaviour change techniques (BCTs) using standardized language can address these challenges and clarify the mechanisms linking system-level PM with individual behaviours. Methods We conducted an analysis of BCTs in a PM system in Ontario, Canada using a modified behaviour change technique taxonomy (BCTT). We reviewed 64 documents, observed 15 meetings and conducted 4 semi-structured interviews with key informants to map the PM interventions on to the taxonomy. Results We identified 54 BCTs spanning 13 taxonomy domains in the PM system. BCTs were concentrated in four domains: (1) goals and planning, (2) reward and threat, (3) feedback and monitoring and (4) identity. The BCTs coded most often included: (1) discrepancy between current behaviour and goal, (2) feedback on outcome(s) of behaviour, (3) social comparison and (4) social incentive/reward. These BCTs suggest that this PM system seeks to change behaviour primarily by directing programme attention to their current performance in relation to the target and in relation to other programs across the province, and by acknowledging good performance with praise or recognition. A total of five PM interventions accounted for 58% of identified BCTs – the scorecard, quarterly performance review reports, quarterly performance review meetings, escalation letter for poor or declining performance and the improvement action plan. Conclusions The results provide a unique analytical and evaluative characterization of the PM system, revealing how a behaviour-change lens on health systems PM can support the (re)design, standardized comparison, and evaluation of PM systems in research and in practice. |
| format | Article |
| id | doaj-art-c2a567a4e3f04c43b772015b97027b26 |
| institution | Kabale University |
| issn | 1478-4505 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | Health Research Policy and Systems |
| spelling | doaj-art-c2a567a4e3f04c43b772015b97027b262025-02-09T13:00:16ZengBMCHealth Research Policy and Systems1478-45052025-02-0123111110.1186/s12961-025-01284-1Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practiceJenna M. Evans0Sarah M. Wheeler1DeGroote School of Business, McMaster University, HamiltonManagement, and Evaluation, Institute of Health Policy, University of TorontoAbstract Background Performance management (PM) systems in healthcare consist of many interacting interventions, such as contracts, scorecards and incentives. The diversity, complexity and poor description of PM interventions hampers replication in research, standardized comparative analysis and accumulation of evidence. Specifying PM systems and interventions in terms of their behaviour change techniques (BCTs) using standardized language can address these challenges and clarify the mechanisms linking system-level PM with individual behaviours. Methods We conducted an analysis of BCTs in a PM system in Ontario, Canada using a modified behaviour change technique taxonomy (BCTT). We reviewed 64 documents, observed 15 meetings and conducted 4 semi-structured interviews with key informants to map the PM interventions on to the taxonomy. Results We identified 54 BCTs spanning 13 taxonomy domains in the PM system. BCTs were concentrated in four domains: (1) goals and planning, (2) reward and threat, (3) feedback and monitoring and (4) identity. The BCTs coded most often included: (1) discrepancy between current behaviour and goal, (2) feedback on outcome(s) of behaviour, (3) social comparison and (4) social incentive/reward. These BCTs suggest that this PM system seeks to change behaviour primarily by directing programme attention to their current performance in relation to the target and in relation to other programs across the province, and by acknowledging good performance with praise or recognition. A total of five PM interventions accounted for 58% of identified BCTs – the scorecard, quarterly performance review reports, quarterly performance review meetings, escalation letter for poor or declining performance and the improvement action plan. Conclusions The results provide a unique analytical and evaluative characterization of the PM system, revealing how a behaviour-change lens on health systems PM can support the (re)design, standardized comparison, and evaluation of PM systems in research and in practice.https://doi.org/10.1186/s12961-025-01284-1Performance managementBehaviour changeHealth system performance |
| spellingShingle | Jenna M. Evans Sarah M. Wheeler Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice Health Research Policy and Systems Performance management Behaviour change Health system performance |
| title | Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice |
| title_full | Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice |
| title_fullStr | Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice |
| title_full_unstemmed | Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice |
| title_short | Opening the black box of health systems performance management using the behaviour change techniques taxonomy: implications for health research and practice |
| title_sort | opening the black box of health systems performance management using the behaviour change techniques taxonomy implications for health research and practice |
| topic | Performance management Behaviour change Health system performance |
| url | https://doi.org/10.1186/s12961-025-01284-1 |
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