An empirical conceptualization of front line enablement by performance management

Figures & data

Table

Overarching topics	Goal	Topics interview questions & probes
Before the interview	Explaining nature and aim of research, reassuring confidentiality, handling of data, and seeking permission and consent	Explaining aim of research project Explaining handling of data Asking permission to audio record interview Asking informed consent
Introduction	Acquiring contextual knowledge Setting the scene of the interview and role expectations	Professional background and experience Current job and activities
Performance measuring in daily work	Acquiring knowledge about role of performance measuring in daily work	Kinds of indicators and systems Reporting activities Time investment
Impact performance measurement systems	Acquiring knowledge about curtailment, continuation, enablement and other consequences	Impact of performance measuring on room for manoeuvre and available resources > More, less, the same or combination > Examples of contexts in which this is experienced Impact of performance measuring on social relations > Clients > Supervisors > Peers Perceived usefulness of indicators/performance measuring systems > Why and how > Examples of different beneficial uses
Impact performance outputs	Acquiring knowledge about curtailment, continuation, enablement	Feedback from higher-up(s) on numbers/percentages resulting from performance measuring > How often; what; how > Examples > Reactions on the shop floor (experiences; verbal; behavioural) Importance of (performance) numbers in daily work > If so, why and how > If not, why not
Values in work	Acquiring knowledge on respondents’ central values in performing their role Signalling the end of the interview	What is deemed important in daily work with clients > Why > Relevance of room for manoeuvre in this > Relevance of performance systems/numbers in this Importance of room for manoeuvre in daily work > Why Importance of working with performance measuring systems > Why
Closing	Exploring other themes left unmentioned but of potential importance for the research Explaining overall planning of research project	Any other themes that respondent would like to address Explaining further planning of the project

Table

Respondent ID	Organization	Department	Job position
PG1	4	House of custody	Prison guard
PG2	4	House of custody/Prison	Prison guard
PG3	5	House of custody	Prison guard
PG4	1	Prison	Prison guard
PG5	1	House of custody; Special care	Prison guard
PG6	1	Prison	Prison guard
PG7	2	Prison	Prison guard
PG8	2	House of custody	Prison guard
PG9	3	House of custody; Special care	Prison guard
PG10	3	House of custody	Prison guard
PM1	4	Security	Prison manager
PM2	5	House of custody	Prison manager
PM3	1	Security	Prison manager
PM4	3	Arrests	Prison manager
PM5	3	House of custody; Special care	Prison manager
PM6	1	Prison	Prison manager
PM7	3	House of custody	Prison manager
HN1	General hospital 4	Anonymized	Hospital nurse; Vice chair of Nurse Advisory Board
HN2	General hospital 4	Neonatology	Hospital nurse
HN3	General hospital 1	Neurosurgery	Hospital nurse
HN4	General hospital 2	Stomach, bowel, liver diseases	Hospital nurse
HN5	Academic hospital 1	Pediatrics	Hospital nurse
HN6	Academic hospital 2	Emergency room	Hospital nurse
HN7	General hospital 3	Obstetrics	Hospital nurse
HN8	Academic hospital 2	Emergency room	Hospital nurse
HM1	General hospital 4	Heart and lung	Hospital manager
HM2	General hospital 5	Pediatrics and obstetrics	Hospital manager
HM3	General hospital 4	Quality and health policy	Hospital manager
HM4	General hospital 3	Pediatrics, obstetrics, neonatology	Hospital manager
HM5	General hospital 4	General	Hospital manager
HM6	General hospital 4	Cardiology	Hospital manager

Table

Fieldnote ID*	Organization	Department(s)	#No units observed	#No of employees observed	Informal conversations with #no of observants**
FN1	1	House of custody; Special care	2	6	6
FN2	1	Prison	1	7	4
FN3	2	Prison	1	6	5
FN4	2	House of custody	1	6	5
FN5	3	House of custody	1	6	3
FN6	3	House of custody; Special care	2	9	5
FN7	3	Arrest	1	6	3
FN8	3	Arrest	2	9	4

*Each fieldnote covers a different day of observations. At some days (see FN1, FN6, FN8) multiple units were visited and observed.

**The number of observants with whom informal conversations were held varies either because of differences in the number of units observed, or because other formal interviews were planned.

Table

Types and subtypes	Content prison context	Number of respondents	Content hospital context	Number of respondents
Knowledge-that
Used to decide	Insight into behaviour of detainee	4 (3 PGs; 1 PM)	Insight into condition of client	4 (4 HNs)
Used to signal	Insight into risky behavioural patterns	1 (1 PG)	Insight into health risks	4 (3 HNs; 1 HM)
Used to evaluate	Insight into how a department is doing	5 (5 PMs)	Insight into safety or quality of treatments	7 (5 HNs; 2 HMs)
Knowledge-how
Cognitive skills
Observing	Keeping one alert	2 (1 PG; 1 PM)	Keeping one alert and preventing overconfidence	5 (4 HNs; 1 HM)
Reflecting	Collectively reflecting to improve	4 (1 PG; 3 PMs)	Collectively reflecting to improve	6 (1 HN; 5 HMs)
Social skills
Relating	Empathizing with clients	4 (2 PGs; 2 PMs)	Informing and adjusting to patients’ wishes	1 (1 HM)
Collaborating	Facilitating information exchange	7 (6 PGs; 1 PM)	Facilitating information exchange	7 (6 HNs; 1 HM)
			Using language of numbers to talk to management	1 (1 HN)
Account-holding	Minimizing favouritism	3 (2 PGs; 1 PM)	Keeping each other in check	1 (1 HN)
Tactical skills
Protecting	From (possible) complaints of higher ups	1 (1 PM)	From (possible) complaints of doctors and clients	3 (3 HNs)
Influencing	Using existing numbers to press for bottom up changes	1 (1 PG)	Using existing numbers and numbers on self-created indicators to press for bottom up changes	5 (4 HNs; 1 HM)
			Proof of performance to external investors and/or insurers	2 (1 HM; 1 HN)

Table

Types and subtypes	Descriptions	Examples input side*	Examples output side**
Knowledge-that
Used to decide	Performance measuring yields insight used for decision making	Prison context Insight into facts needed to reward someone Nursing context Assessment of a patient’s situation to provide the needed care	-
Used to signal	Performance measuring yields signalling knowledge	Prison context Insight into visible behaviours that signal likely invisible behaviours Nursing context Insight into risks of a patient developing potential health conditions	-
Used to evaluate	Performance measuring yields evaluative knowledge	Nursing context In case of a mistake, retrospective insight into why a certain decision was made	Prison context Insight into where department with teams are standing compared to others Nursing context Insight into mistakes or things that go wrong around certain tools raising questions on their reliability and safety
Knowledge-how
Cognitive skills
Observing	Performance measuring stimulates observation skills	Prison context Discussing input on detainees in multidisciplinary teams keeps one on their toes Nursing context Keeping score lists keeps one alert and prevents overconfidence	-
Reflecting	Performance measuring encourages collective reflection to improve practices	Prison context Reflecting on frontline actions because of recordings Nursing context Reflecting on choice of internal indicators (amount and type) in consultation with other stakeholders	Prison context Reflecting on ‘the why’ behind the scores in consultation with colleagues to discuss what can be improved Nursing context Reflecting on ‘the why’ behind scores and making care agreements or team indicators together within teams on regular basis
Social skills
Relating	Performance measuring encourages relating with clients	Prison context Stimulating conversations with detainees on their behaviour and adjusting one’s approach to a detainee based on assessment	Nursing context Communicating indicator scores on treatments to patients and adjusting to patients’ wishes
Collaborating	Performance measuring facilitates collaboration	Prison context Facilitating information exchange within the organization to create a full picture Nursing context Facilitating transfer of information to and collaboration with other shift and disciplines	Nursing context Creating a common language based on numbers to talk to management
Account-holding	Performance measuring encourages accountability practices	Prison context Minimizing possibility of favouritism Nursing context Recording for indicators keeps everyone in check	-
Tactical skills
Protecting	Performance measuring protects from (possible) complaints	Prison context Using recordings on indicators to protect from possible complaints from higher-ups Nursing context Using recordings on indicators to protect from possible patient complaints	-
Influencing	Performance measuring empowers to press for bottom-up changes	-	Prison context Pressing for changes using existing indicator scores Hospital context Pressing for changes using scores on existing or self-created indicators Providing proof of performance to investors or insurers

*The input side refers to the act of recording or discussions of specific recordings on performance indicators.

**The output side refers to the use of numerical performance output on the aggregate level of a team, department or organization.