Background
Conceptual framework
Characteristics of the Lombardy region health care system and its performance measurement system
Strategic use of non-financial PMS, process improvements and perceived managerial discretion
Hypothesis 1
Hypothesis 2
Perceived managerial discretion and process improvement
Hypothesis 3
Hypothesis 4
Methods
Sample selection and data collection
Hospitals | Sample managers | ||
---|---|---|---|
Type of hospitals | Private | 2 | 23 |
Public | 5 | 102 | |
Total | 7 | 125 | |
Complexity of hospitals | Research | 3 | 38 |
Teaching | 4 | 87 | |
Total | 7 | 125 | |
Avg number of beds | 852.99 | 23 | |
Avg catchment area | 502,352 | 27,840 | |
Gender | Male | 90 | 101 |
Female | 35 | 24 | |
Total | 125 | 125 |
Variable measurement
Research variable name | Survey questions addressed to health care managers and variable items | Variable measurement | Frequency distribution for survey questions (in %) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | |||
Strategic Use of Non-Financial Performance Measurement Systems
| How would you rate the relevance in the use of non-financial PMS in detecting straegic uncertainties within your organizational unit? | A score from 1 to 7 on a Likert scale (1 Extremely unsatisfactory,…, 7 Extremely satisfactory) | 2.062 | 10.309 | 14.433 | 29.897 | 21.649 | 17.526 | 4.124 | |
Perceived Managerial Discretion
| Decision Making: What is your perception about the effectiveness of the non-financial performance system used in providing information with reference to support operational decisions of your unit? | Decision making: a score from 1 to 7 on a Likert scale (1 Extremely unsatisfactory,…, 7 Extremely satisfactory) | 2.062 | 6.186 | 11.34 | 11.34 | 19.588 | 39.175 | 10.309 | |
Flexibility: What is your perception on the effectiveness of the non-financial performance system used in providing information with reference to enabling the flexibility/adaptability of your organizational unit? | Flexibility: a score from 1 to 7 on a Likert scale (1 Extremely unsatisfactory,…, 7 Extremely satisfactory) | 4.124 | 6.186 | 12.371 | 22.68 | 22.68 | 27.835 | 4.124 | ||
Improved Processes
| Did your organizational unit introduce improved processes during the last three years? | A score from 1 to 7 on a Likert scale (1 Very much less than sector’s average,…, 7 Much greater than sector’s average). 0 if no improved processes have been introduced during the last three years. | 18.557 | 2.062 | 5.155 | 9.278 | 14.433 | 28.866 | 18.557 | 3.093 |
Tenure
| Time: How long have you been with the company? | Time: respondent has to indicate years and months (0 < "1" ≤ 5 years; 5 < "2" ≤ 10 years; 10 < "3" ≤ 15 years; 15 < "4" ≤ 20 years; 20 < "5" ≤ 25 years; 25 < "6" ≤ 30 years; "7" > 30 years) | 40.206 | 7.216 | 5.155 | 7.216 | 17.526 | 8.247 | 10.309 | |
Time actual: How long have you been in the current job? | Time actual: respondent has to indicate years and months (0 < "1" ≤ 3 years; 3 < "2" ≤ 6 years; 6 < "3" ≤ 9 years; 9 < "4" ≤ 12 years; 12 < "5" ≤ 15 years; 15 < "6" ≤ 18 years; "7" > 18 years) | 38.144 | 28.866 | 10.309 | 9.278 | 3.093 | 3.093 | 3.093 | ||
Gender
| Women/Men managers | A dichotomous variable: 0 if respondent is a man and 1 if respondent is a woman. | 79.381 | 20.619 | ||||||
Environmental Uncertainty
| Complexity: What is the level of complexity faced in your unit’s environment compared to the average of the sector you belong to? | Complexity: A score from 1 to 7 on a Likert scale (1 Very much less than sector’s average,…, 7 Much greater than sector’s average) | 0 | 0 | 8.247 | 24.742 | 19.588 | 34.021 | 13.402 | |
Risk: What is the level of risk faced in your unit’s environment compared to the average of the sector you belong to? | Risk: A score from 1 to 7 on a Likert scale (1 Very much less than sector’s average,…, 7 Much greater than sector’s average) | 1.031 | 4.124 | 15.464 | 27.835 | 30.928 | 17.526 | 3.093 | ||
Uncertainty: What is the degree of uncertainty faced in your unit’s environment compared to the average of the sector you belong to? | Uncertainty: A score from 1 to 7 on a Likert scale (1 Very much less than sector’s average,…, 7 Much greater than sector’s average) | 2.062 | 8.247 | 7.216 | 42.268 | 27.835 | 10.309 | 2.062 |
Research model
Variable | Number | Factor Loading (p-value) | Min | Max | Mean | Standard Deviation | AVE (Average Variance Extracted) | Composite Reliability | Chronbach's Alpha | CVR (Cross-Validated Redundancy) | Effect size (f2) | Perceived Managerial Discretion Pearson (Sig two-tailed) | Improved Processes Pearson (Sig two-tailed) | Strategic Use of Non-Financial Performance Measurement Systems Pearson(Sig two-tailed) | Tenure Pearson (Sig two-tailed) | Gender Pearson (Sig two-tailed) | Environmental Uncertainty Pearson (Sig two-tailed) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Perceived Managerial Discretion
| 97 | 1 | 7 | 4.763 | 1.429 | 0.914 | 0.955 | 0.906 | 0.301 | 0.017 | 1 | ||||||
Decision Making
| 0.955 (a) | 1 | 7 | 4.990 | 1.510 | ||||||||||||
Flexibility
| 0.957 (a) | 1 | 7 | 4.540 | 1.479 | ||||||||||||
Improved Processes
| 97 | 0 | 7 | 3.760 | 2.168 | 0.050 | 0.254; (0.012b) | 1 | |||||||||
Strategic Use of Non-Financial Performance Measurement Systems
| 97 | 1 | 7 | 4.280 | 1.405 | 0 | 0.381 | 0.581; (0.000c) | 0.121; (0.250) | 1 | |||||||
Tenure
| 92 | 0 | 55 | 17.804 | 14.430 | 0.781 | 0.876 | 0.727 | 0 | 0.022 | 0.238; (0.022b) | 0.121; (0.250) | 0.222; (0.033b) | 1 | |||
Time
| 0.925 (a) | 0 | 37 | 13.043 | 11.222 | ||||||||||||
Time Actual
| 0.840 (a) | 0 | 20 | 4.7310 | 4.658 | ||||||||||||
Gender
| 94 | 0 | 1 | 0.210 | 0.411 | 0 | 0.003 | 0.138; (0.186) | 0.032; (0.757) | 0.145; (0.164) | 0.223; (0.034b) | 1 | |||||
Environmental Uncertainty
| 97 | 2 | 7 | 4.643 | 0.952 | 0.612 | 0.823 | 0.702 | 0 | 0.021 | 0.176; (0.085) | 0.082; (0.422) | 0.143; (0.163) | −0.198; (0.059) | −0.131; (0.209) | 1 | |
Complexity
| 0.823 (a) | 3 | 7 | 5.200 | 1.196 | ||||||||||||
Risk
| 0.868 (a) | 1 | 7 | 4.480 | 1.217 | ||||||||||||
Uncertainty
| 0.638 (a) | 1 | 7 | 4.250 | 1.191 |
Direct Model | Indirect Model | ||
(a) | (b) | ||
n = 97 |
n = 97 | ||
Variable (Y) | R square | R square | |
Perceived Managerial Discretion | 36.30% | ||
Improved Processes | 6.80% | 8.40% | |
Path coefficient
|
Direct Path Coefficient
|
Indirect Path Coefficient
| |
(P-value) | (P-value) | (P-value) | |
Perceived Managerial Discretion- > Improved Processes
| 0.154 | ||
(0.138) | |||
Strategic Use of Non-Financial Performance Measurement Systems - > Perceived Managerial Discretion
| 0.524 | ||
(0.000a) | |||
Strategic Use of Non-Financial Performance Measurement Systems - > Improved processes
| 0.261 | 0.171 | 0.081 |
(0.008a) | (0.118) | (0.189) | |
Tenure- > Perceived Managerial Discretion
| 0.129 | ||
(0.136) | |||
Gender- > Perceived Managerial Discretion
| 0.045 | ||
(0.579) | |||
Environmental Uncertainty- > Perceived Managerial Discretion
| 0.121 | ||
(0.257) | |||
Environmental Uncertainty- > Improved Processes
| 0.019 | ||
(0.437) | |||
Gender- > Improved Processes
| 0.007 | ||
(0.657) | |||
Tenure- > Improved Processes
| 0.020 | ||
(0.350) |