Blunt tools: Performance measurement in policies for health care

Pollitt, Christopher

doi:10.1016/0305-0483(84)90032-x

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…Most of the research here is being undertaken in the USA. The nature of this approach is described elsewhere (Pollitt 1984): suffice it to point out there that, in principle, it has two great attractions. First, it necessarily engages the attention of clinicians -it is not a top-down administrative exercise.…”

Section: Future Developmentsmentioning

confidence: 99%

Measuring Performance: A New System for the National Health Service

Pollitt¹

1985

Policy &Amp; Politics

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On 22nd September 1983 the Department of Health and Social Security issued the first national package of ‘performance indicators’ to the 14 Regional Health Authorities (RHAs) and 192 District Health Authorities (DHAs) which make up the National Health Service in England. Introducing this central government initiative, the junior minister said that it gave ‘local managers, for the first time, the facility to compare local performance with what is happening elsewhere in the NHS’ (Department of Health and Social Security 1983). The DHSS also set up a DHSS/NHS Joint Working Party on Performance Indicators, which at the time of writing has still to produce its recommendations for developing the present indicator set. After only one year’s experience of the new system, any judgements must of necessity be tentative. This paper is based on correspondence with more than 100 of the 207 Regional and District Health Authorities (hereafter RHAs and DHAs), supplemented by a literature search and a dozen lengthy interviews with District Administrators and other officials with significant roles in the 1983 initiative.

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Section: Future Developmentsmentioning

confidence: 99%

Measuring Performance: A New System for the National Health Service

Pollitt¹

1985

Policy &Amp; Politics

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“…After an initial ministerial fanfare the evidence is that use of the first (1983) package was patchy. Few District or Regional Health Authorities found the indicator data particularly reliable or relevant to their key flows of decision-making (Pollitt, 1984a and1985a). The medical profession, the crucial actors in terms of local resource-commitment, remained at most lukewarm.…”

Section: Pollitt the Wave Of Performance Assessmentmentioning

confidence: 99%

Beyond the Managerial Model: The Case for Broadening Performance Assessment in Government and the Public Services

Pollitt¹

1986

Financial Acc & Man

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One does not have to dig too deep into the mass of recent documentation about improving management in the public services sector to see the bureaucracy of the future. The department of the future will have a clear set of strategic objectives. Within it each division and section will have its own objectives, more detailed, of course, but directly related to the overall strategy. Each individual manager will work to an annually renegotiated set of personal targets, performance against which will figure as an important factor in hidher superiors' decisions about merit pay increases, promotion and training. More staff than in the past will be employed on term contracts -the concept of a lifetime career in public service will become less common. Specialist skills, in particular, will be 'bought in' for specific projects. A sophisticated system of activity costing will encourage keen awareness of resource use at all levels in the hierarchy. Financial responsibility will be more dispersed than has been common in central or local government in the past. 'Cost centres' will be widely used, with senior management more concerned with maintaining and developing control systems than with approving specific decisions. Personnel management responsibility will also have to be decentralized, and line management will be expected to seek those combinations of all resources which yield the best value for the taxpayer's money. All this would be underpinned by computerized information systems.It is this vision of the future that shines out from many of the official publications cited throughout the remainder of this article. Compared with what is known of the past, it is an impressive conception. Dynamic, performanceoriented management assumes centre stage, displacing older traditions of rulefollowing generalist administration. The author however, wishes to argue that the emerging 'new managerialism' has thus far been conceived in dangerously narrow terms. To show this, one of the central concepts in the management model -that of 'performance', will be examined more closely.

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“…Hence measures, such as “profit” or “disability states”, should not be confused with the underlying concepts of concern, such as “economic growth” or “health” (see Holland, 1983, pp. 39‐41; Pollitt, 1984, p. 136).…”

Section: Problems With Performance Measuresmentioning

confidence: 99%

“…One of the more challenging tasks facing policy makers in the public sector is to decide whether and to what extent performance indicators should be applied to the assessment of management. A myriad criticisms have accompanied the use of indicators in this regard (Broadbent et al , 1991; Canadian Comprehensive Accounting Foundation, 1987; Carpenter, 1990; Pollitt, 1984, p. 132, 1986; Smith, 1992; Williams, 1985). The criticisms fall into two broad categories: first, that performance indicators are deceptive because they falsely convey an impression of objective truth; second, that by making certain aspects of performance visible, they marginalize other management activities.…”

Section: Introductionmentioning

confidence: 99%

“…At the risk of falling down the hole in the middle of the road (Tinker et al , 1991), we suggest that there is social value in the disclosure of performance measures and that conducting a review of measures is a worthwhile enterprise. This is because performance indicators can be useful to a broad range of users (Pollitt, 1984, p. 132; Ware et al , 1981) and can address important social as well as economic needs (Churchman, 1971; Culyer, 1983; Perks and Glendinning, 1981; Smith, 1990). We therefore assume that the disclosure of performance measures can increase social discourse, engage participants who would otherwise be marginalized from the debate and thereby contribute to socially desirable outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Health management performance

Peursem

Prat

Lawrence

1995

Accounting, Auditing &Amp; Accountability Journal

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A bewildering variety of performance measures and indicators in health management is evident in the literature and in practice. Reviews measures useful for health management performance accountability, and expands on the traditional notion of health performance measures to incorporate nominal and ordinal measures. The research is performed in the interest of stimulating discussion in the public domain and with the intent of expanding current notions of the term “performance indicator”. Develops a comprehensive framework from measurement and accountability theory, and the medical management, accounting and accountability literatures are reviewed. Highlights the importance of using non‐ratio measures to capture outcomes, structure and processes influenced by management; and suggests that disclosures which include measures from all elements of the framework would most closely account for management activity.

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Blunt tools: Performance measurement in policies for health care

Cited by 8 publications

References 13 publications

Measuring Performance: A New System for the National Health Service

Measuring Performance: A New System for the National Health Service

Beyond the Managerial Model: The Case for Broadening Performance Assessment in Government and the Public Services

Health management performance

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