Performance-based accountability in the United States organ procurement system.

摘要

The organ procurement program within the United States has been structured since inception as a public-non-private partnership between the Centers for Medicare and Medicaid Services (CMS) and organ procurement organizations (OPOs). Unlike many public programs, the partnership relationship has been anchored in a performance-based accountability approach where failure to meet performance expectations resulted in revocation of operating certification and organizational dissolve.;This study applied a performance management framework, introduced by Joseph Wholey (1999), to the organ procurement policy chronology to test select propositions about performance-based accountability and to offer evidence to support improving the existing framework. The Wholey (1999) framework included six performance criterion including: agreed-on goals and strategies, performance measurement systems, performance-based management systems, accountability, demonstrating effective performance, and supporting resource allocation or other policy decision-making.;The study required development of the organ procurement policy chronology covering two decades with emphasis on actors and behaviors within the units of analyses which were the policy, administrative and operational environments. By very nature the study was qualitative and incorporated evidence derived from documents, archival records and interviews. Whenever possible, data were converged using a multi-method and multi-source approach designed to improve study validity.;For context setting, the study included a broad review of published literature on performance management and reform strategies as well as a summary of organ procurement-related research. The later included an emphasis on efforts to boost organ supply, financial incentives to improve donation, examining alternative structures to the "expressed consent" framework, and identification of optimal methods for determining OPO performance.;When applying the performance management framework to the chronology the author found both favorable consequences of a performance-focused approach as well as notable challenges. The study's posited research questions and propositions were teased out and nine new propositions about performance management were generated. Lessons learned addressed performance barriers, the political dimension of performance management, the role of communication, recognizing emerging technologies, the importance of incentives, early agreement among partners, and anticipating an expansion in the number and breadth of performance measures. These lessons were recapitulated at the conclusion of the study in the form of opportunities for further research.