Perception of Performance Measurement Systems: The Case of Control Rooms Implemented in Health Organizations

Abstract

This study examines the perception of control rooms, a performance measurement system (PMS) derived from Lean management adopted in Québec's public sector. Our main objective is to understand how managers perceive this new PMS within a context of existing accountability controls. Drawing on the enabling control framework to conceptualize managers’ perceptions throughout the PMS's development process and subsequent ongoing use, a case study was conducted in two large healthcare organizations. The findings show that, despite initial skepticism due to existing accountability controls and top‑down imposition, managers in Quebec's public health sector came to perceive control rooms as a useful PMS for continuous improvement. Managers resolved the tensions resulting from the cohabitation of both types of control by rationalizing the need for accountability and by integrating the two controls. The study contributes to our understanding of PMSs adoption in the public sector literature by focusing on perception rather than the impact on performance. Specifically, it supports the idea that perceptions evolved over time and that an enabling development process fosters users’ appropriation process of the new PMS. Moreover, we document that PMSs for continuous improvement and for hierarchical controls can complement each other.