Performance in healthcare: a conceptual analysis

The concept of “performance” is widely used across disciplines, yet remains ambiguously defined, particularly in healthcare. This conceptual ambiguity poses challenges for researchers, managers, and policymakers in effectively evaluating and improving organisational outcomes in complex environments such as hospitals. This study employed Rodgers’ evolutionary concept analysis method to clarify the concept of “performance” in healthcare. The process involved: (1) identifying the concept of interest; (2) determining surrogate terms and relevant uses; (3) selecting an appropriate realm for data collection through systematic literature searches in PubMed, Scopus, Web of Science, and Google Scholar; (4) identifying attributes of the concept; (5) determining antecedents and consequences; (6) analyzing related concepts; and (7) generating a model case. The analysis was further refined through multiple focus group discussions using brainstorming techniques with healthcare experts to consolidate performance-related dimensions. The analysis revealed significant inconsistencies in how performance is defined and measured in healthcare literature. We identified 21 distinct performance dimensions, which were integrated into a novel four-level framework termed the Umbrella Performance Model (UPM). This model positions performance as a conceptual-descriptive framework that integrates not only traditional elements such as productivity, efficiency, and effectiveness, but also 18 additional, healthcare-specific dimensions, that clarify performance boundaries and interrelationships. The UPM provides a unified framework for understanding performance in healthcare organisations, particularly hospitals. By introducing this model, the study aims to reduce conceptual ambiguity and offer a holistic approach to performance evaluation that moves beyond traditional efficiency-based metrics. The model serves as a practical guide for health service researchers, managers, and policymakers to assess and improve organisational performance more comprehensively.