ArticleBMJ global health2021
Performance management in complex adaptive systems: a conceptual framework for health systems.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Retrospective analysis of a surgical service in a rural district hospital in the Eastern Cape.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2026Article
- Building a health system resilience framework: national, state, regional, and local perspectives.Lancet regional health. Americas · 2026Review
- Adaptive Performance in Healthcare: The Role of Collaboration-Oriented Leadership, Work Engagement, Group Identification, and Change Predisposition.Journal of nursing management · 2026Article
- How do clinical networks operationalize safety and quality stewardship? A qualitative study of Australian clinical networks.Health research policy and systems · 2025Article
- Evaluation of the performance of telephone triage service.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Managing and measuring performance of health prevention services: a simulation-based approach.Journal of health organization and management · 2025Article
- The effects of decentralized financing and funding levels on the breadth of services and structural quality to provide those services in primary health facilities in Nigeria.BMC health services research · 2025Article
- 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 · 2025Article
- The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria.JMIR public health and surveillance · 2024Article
- Cultivating leaders for primary health care: A revised approach for transformative development.African journal of primary health care & family medicine · 2024Article
- Redefining leadership within the NHS' complex adaptive system.Future healthcare journal · 2024Article
- Characterising the performance measurement and management system in the primary health care systems of Malawi.African journal of primary health care & family medicine · 2024Article
- Characterizing the implementation of performance management interventions in a primary health care system: a case study of the Salud Mesoamerica Initiative in El Salvador.Health policy and planning · 2023Article
- Rethinking Performance Measurement of Primary Care in China Comment on "Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China".International journal of health policy and management · 2023Article
- Article
- Linking resilience and regulation across system levels in healthcare - a multilevel study.BMC health services research · 2022Article
- A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum.Journal of medical education and curricular developmentArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.