Measuring quality for human service improvement: How nonprofits meet the quality requirements of public authorities

• Date: 01 September 2020
• DOI: http://doi.org/10.1002/nml.21416
• Author: Roger Pfiffner
• Published date: 01 September 2020

RESEARCH ARTICLE

Measuring quality for human service

improvement: How nonprofits meet the quality

requirements of public authorities

Roger Pfiffner

KPM Center for Public Management,

University of Bern, Bern, Switzerland

Correspondence

Roger Pfiffner, KPM Center for Public

Management, University of Bern,

Schanzeneckstrasse 1, 3001 Bern,

Switzerland.

Email: roger.pfiffner@bfh.ch

Abstract

The growing pressure for service quality has led to an

increase in the dissemination of quality models in non-

profit human service organizations. In spite of this, lit-

tle is known about their implementation. The present

study therefore examines how quality management

directives imposed by public authorities affect the

adoption and use of quality measurement systems

under different sets of conditions. Key findings, based

on survey data from 536 human service nonprofits in

Switzerland, suggest that external quality requirements

foster the adoption of measurement systems to the

greatest degree, but simultaneously reduce their actual

utilization for service improvement. The strength of

these effects is contingent on the organizations'

resources and the quality of indicators. Managers' com-

mitment to quality measurement shows the strongest

effect on the use of quality measurement systems.

These findings and the implications for future research

and practice will be discussed.

KEYWORDS

human service organizations, measurement system, nonprofit

management, organizational learning, quality management

1|INTRODUCTION

Assessing and improving the quality of human services is an urgent policy, practice, and

research concern (Bunger & Lengnick-Hall, 2019). Nonprofit human service organizations are

Received: 20 November 2018 Revised: 4 May 2020 Accepted: 7 May 2020

DOI: 10.1002/nml.21416

Nonprofit Management and Leadership. 2020;31:103–127. wileyonlinelibrary.com/journal/nml © 2020 Wiley Periodicals LLC 103

increasingly being held accountable for the quality of their services and, consequently, are fac-

ing growing pressure to undertake more systematic efforts to assess the internal capacities of

the organization, enhance outcomes, and report their achievements to supervisory authorities

(B. Lee & Clerkin, 2017; B. R. Lee, McMillen, Knudsen, & Woods, 2007). Changing client

needs and fiscal austerity also require appropriate actions to prevent service failures or a decline

in service quality. As a consequence, there has been a significant increase in the adoption of

quality models such as the European Foundation for Quality Management (EFQM) Excellence

model, the Common Assessment Framework (CAF), models based on the quality management

standards set by the International Organization for Standardization (ISO 9001) or related man-

agement frameworks (Cairns, Harris, Hutchison, & Tricker, 2005; Mahmoud, Alatrash,

Fuxman, Hack-Polay, & Grigoriou, 2019; Mel~

ao, Bastida, & Marimon, 2019).

A common feature of quality models is that they include measurement procedures that pro-

vide various types of nonfinancial information that reflect internal organizational capabilities,

stakeholder needs, and intermediate outcomes (Talbot, 2010; Van Dooren, 2008). One of the

underlying assumptions of quality models is that urging organizations to generate such infor-

mation helps supervisory authorities to hold them accountable (Carnochan, Samples, Myers, &

Austin, 2014; LeRoux & Wright, 2010). As human service nonprofits often fulfill vital human

needs and provide services to vulnerable clients, it is essential to prevent any quality deficien-

cies that could pose a threat to health or wellbeing (Mel~

ao & Guia, 2015). Moreover, promoters

of quality models believe that a balanced set of quantitative indicators facilitates a holistic

assessment of service quality, helps managers to identify problems, and thus provides additional

feedback information to target continuous quality improvement initiatives (Evans & Lindsay,

2017; Kaplan, 2001).

Although quality models have become widespread in the European nonprofit sector, only a

small number of empirical studies have investigated their adoption, use, and impact

(e.g., Cairns et al., 2005; Mel~

ao & Guia, 2015). The majority of the current research on perfor-

mance interventions in the nonprofit sector is focused on performance management and the

use of outcome measures, and thus has a somewhat different focus. That research shows,

among other things, that accountability and funding requirements from external stakeholders

are one of the main reasons that nonprofits measure the performance of their organization, but

that there is considerable variation in the extent to which organizations respond to those

demands (B. Lee & Clerkin, 2017; MacIndoe & Barman, 2013). The present study builds on

this research, but shifts the focus onto two important, hitherto largely neglected aspects.

The first key contribution of our study is that it goes some way toward bridging the research

gap on the introduction of quality models, highlighting the key success factors and challenges

for quality measurement approaches in a nonprofit human service context. In doing so, unlike

most previous studies, we focus on quality approaches with a strong focus on micro-level issues

such as organizational capacities and procedures, staff, and client satisfaction (Talbot, 2010;

Van Dooren, 2008). Quality indicators are thus closer to the core activities of an organization

than information concerning results on the meso- or macro-level, which begs the question of

whether the former type of indicators can be more easily used for service improvements.

The second contribution of the study is that it provides a better understanding of how non-

profits respond to quality management requirements imposed by funders and regulators. So far,

the existing research has identified a number of variables with a direct effect on the adoption

and use of measurement systems, but it has rarely considered indirect and contingency effects

(see Kroll, 2015a). In particular, only a small number of large-scale studies have investigated

the complex interrelationships between external accountability demands and internal

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