Perceptions of Performance Measurement Systems among Clinical Managers: Implications for Waiting Time reduction

. This paper investigates whether clinical unit managers' perceptions of performance measurement systems (PMS) influence service outcomes, specifically patient waiting time (WT) in specialized medical care. Reducing WT is a major challenge, as delays can compromise health outcomes and impact patient satisfaction. Drawing on theories of planned behaviour and organizational commitment, we hypothesize that when managers perceive PMS tools as indispensable, they are more likely to engage with them, leading to improved unit performance. Based on survey data from 67 clinical units in public hospitals in Galicia (Spain) and official WT records, we analyse the association between PMS perception and service performance using contingency tables. The results indicate that perceiving performance measurement systems as essential by clinical unit managers is significantly associated with reduced patient waiting times The article's innovative contributions lie in its focus on PMS at the middle-management —specifically clinical unit managers—rather than at the broader and more commonly studied health system level. Furthermore, it examines the effectiveness of PMS when used by physician-managers, rather than by general administrative leadership. Our findings underscore the importance of managerial perception in the successful implementation of PMS and provide practical implications for policymakers and hospital administrators. Specifically, they suggest that improving managerial training can enhance efficiency and patient outcomes.